Healthcare Provider Details

I. General information

NPI: 1366558447
Provider Name (Legal Business Name): MADONNA L GRABOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 S LAKE PARK AVE SUITE D
HOBART IN
46342-5961
US

IV. Provider business mailing address

1265 S LAKE PARK AVE SUITE D
HOBART IN
46342-5961
US

V. Phone/Fax

Practice location:
  • Phone: 219-945-1538
  • Fax: 219-945-0151
Mailing address:
  • Phone: 219-945-1538
  • Fax: 219-945-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05001448A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: