MEDICARE: HEATHER GRONKOWSKI

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
1	225100000X	Physical Therapist	047948	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942951173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GRONKOWSKI

Provider Business Mailing Address
First Line	:	4225 GENESEE ST STE 400
Second Line	:
City	:	CHEEKTOWAGA
State	:	NY
Zip	:	14225-1994
Country	:	US
Telephone Number	:	716-204-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WASHINGTON ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-3023
Country	:	US
Telephone Number	:	716-204-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	02/24/2025

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Directions to “ HEATHER GRONKOWSKI ” Practice Location

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