Healthcare Provider Details

I. General information

NPI: 1720086549
Provider Name (Legal Business Name): LEONARD A GRIECO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRAC REHAB PEACH 5100 PEACH STREET
ERIE PA
16509
US

IV. Provider business mailing address

717 STATE ST SUITE 16,LL
ERIE PA
16501-1341
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-5097
  • Fax: 814-864-9583
Mailing address:
  • Phone: 814-480-7100
  • Fax: 814-480-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT000355E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: