Healthcare Provider Details

I. General information

NPI: 1457649568
Provider Name (Legal Business Name): JENNIFER LYNN GRZEBINSKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 BROADWAY ST
LANCASTER NY
14086-9523
US

IV. Provider business mailing address

27 GARNET DR
CHEEKTOWAGA NY
14227-2449
US

V. Phone/Fax

Practice location:
  • Phone: 716-684-3000
  • Fax:
Mailing address:
  • Phone: 716-656-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: