Healthcare Provider Details

I. General information

NPI: 1528032026
Provider Name (Legal Business Name): STEPHANIE GRZYMSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE BUCHINSKI

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/04/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MAIN ST
FOREST CITY PA
18421-1418
US

IV. Provider business mailing address

W RIDGE ST
NANTICOKE PA
18634
US

V. Phone/Fax

Practice location:
  • Phone: 570-785-2018
  • Fax: 570-785-2061
Mailing address:
  • Phone: 570-466-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT000376
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: