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NPI Code Detail

MEDICARE: MR. LARRY JOEL GROLLMAN ATC

MEDICARE: MR. LARRY JOEL GROLLMAN ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerRT000249APA

General Provider Information

NPI Number : 1225023195
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY JOEL GROLLMAN ATC
Provider Business Mailing Address
First Line : 100 HALSEY CT
Second Line :
City : PITTSBURGH
State : PA
Zip : 15228-1765
Country : US
Telephone Number : 412-432-3770
Fax Number : 412-432-3774
Provider Business Practice Location Address
First Line : 3200 S WATER ST
Second Line : ROOM 224
City : PITTSBURGH
State : PA
Zip : 15203-2307
Country : US
Telephone Number : 412-432-3770
Fax Number : 412-432-3774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 07/08/2007

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Directions to “ MR. LARRY JOEL GROLLMAN ATC” Practice Location

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