Provider Demographics
NPI:1144600628
Name:GRANDELSKI, JENI (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENI
Middle Name:
Last Name:GRANDELSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06374-1036
Mailing Address - Country:US
Mailing Address - Phone:860-564-4081
Mailing Address - Fax:
Practice Address - Street 1:16 WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1036
Practice Address - Country:US
Practice Address - Phone:860-564-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist