Healthcare Provider Details

I. General information

NPI: 1205187390
Provider Name (Legal Business Name): REBECCA W GRYGALONIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA DAWN WARD-GRYGALONIS DPT

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 ATLEE RD STE D
MECHANICSVILLE VA
23116-1815
US

IV. Provider business mailing address

8201 ATLEE RD STE D
MECHANICSVILLE VA
23116-1815
US

V. Phone/Fax

Practice location:
  • Phone: 804-569-1787
  • Fax: 804-569-9787
Mailing address:
  • Phone: 804-569-1787
  • Fax: 804-569-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207549
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: