Provider Demographics
NPI:1437111689
Name:GRILLO, ANTHONY M (PT, DPT, OCS, CIMT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:M
Last Name:GRILLO
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CIMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:4125 IRONBOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-220-8383
Practice Address - Fax:757-253-7833
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192931OtherBCBS PHYSICAL THERAPY
VA010082528Medicaid
7925461OtherAETNA
VAP00157303OtherRAILROAD MEDICARE
VAP00157303OtherRAILROAD MEDICARE
VA010082528Medicaid