Provider Demographics
NPI:1326175530
Name:GRUNEWALD, THOMAS H (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:GRUNEWALD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E 46TH ST # 8FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2418
Mailing Address - Country:US
Mailing Address - Phone:212-499-0876
Mailing Address - Fax:212-953-1353
Practice Address - Street 1:17 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0302
Practice Address - Country:US
Practice Address - Phone:212-988-2501
Practice Address - Fax:212-988-2509
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
014761-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QP5631Medicare PIN