Provider Demographics
NPI:1417725326
Name:GILROY, GRACE C (LMT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:GILROY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-2927
Mailing Address - Country:US
Mailing Address - Phone:917-680-1954
Mailing Address - Fax:
Practice Address - Street 1:214 MAC ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7011
Practice Address - Country:US
Practice Address - Phone:917-680-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty