Healthcare Provider Details

I. General information

NPI: 1710605654
Provider Name (Legal Business Name): DYLON GRZENDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TURNPIKE ST
NORTH ANDOVER MA
01845-5800
US

IV. Provider business mailing address

11 GALWAY DR
NORTH ATTLEBORO MA
02760-6506
US

V. Phone/Fax

Practice location:
  • Phone: 978-837-5000
  • Fax:
Mailing address:
  • Phone: 508-406-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: