Healthcare Provider Details

I. General information

NPI: 1023295532
Provider Name (Legal Business Name): GEOFFREY GRELL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LATTIMORE RD STE 178
ROCHESTER NY
14620-4159
US

IV. Provider business mailing address

125 LATTIMORE RD STE 178
ROCHESTER NY
14620-4159
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-9110
  • Fax: 585-442-9049
Mailing address:
  • Phone: 585-442-9110
  • Fax: 585-442-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number029934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: