Healthcare Provider Details

I. General information

NPI: 1710894431
Provider Name (Legal Business Name): GRACE KATHLEEN LAGULLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 5TH AVE
OAKLAND PA
15213-3583
US

IV. Provider business mailing address

101 N DITHRIDGE ST APT 601
PITTSBURGH PA
15213-2652
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-4141
  • Fax:
Mailing address:
  • Phone: 908-391-5411
  • 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: