Provider Demographics
NPI:1326226804
Name:GRELL, KATHRYN M (MSPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:GRELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:M
Other - Last Name:JABLONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 COLLINS STREET
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414
Mailing Address - Country:US
Mailing Address - Phone:585-226-2480
Mailing Address - Fax:585-226-2494
Practice Address - Street 1:490 COLLINS ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-1466
Practice Address - Country:US
Practice Address - Phone:585-226-2480
Practice Address - Fax:585-226-2494
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist