Provider Demographics
NPI:1225023195
Name:GROLLMAN, LARRY JOEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JOEL
Last Name:GROLLMAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HALSEY CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1765
Mailing Address - Country:US
Mailing Address - Phone:412-432-3770
Mailing Address - Fax:412-432-3774
Practice Address - Street 1:3200 S WATER ST
Practice Address - Street 2:ROOM 224
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-2307
Practice Address - Country:US
Practice Address - Phone:412-432-3770
Practice Address - Fax:412-432-3774
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000249A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer