Provider Demographics
NPI:1437389145
Name:GRUNITZKY, TAMARA C (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:C
Last Name:GRUNITZKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:C
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1777 REISTERSTOWN ROAD
Mailing Address - Street 2:SUITE 130 EAST
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-415-5905
Mailing Address - Fax:410-415-5906
Practice Address - Street 1:1777 REISTERSTOWN ROAD
Practice Address - Street 2:SUITE 130 EAST
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-415-5905
Practice Address - Fax:410-415-5906
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist