Provider Demographics
NPI:1467991497
Name:GRONOWETTER, YULIYA RYBATSKAYA (PT)
Entity Type:Individual
Prefix:MRS
First Name:YULIYA
Middle Name:RYBATSKAYA
Last Name:GRONOWETTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:YULIYA
Other - Middle Name:
Other - Last Name:RYBATSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:159 STEEP HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-1923
Mailing Address - Country:US
Mailing Address - Phone:917-710-3357
Mailing Address - Fax:
Practice Address - Street 1:159 STEEP HILL RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:CT
Practice Address - Zip Code:06883-1923
Practice Address - Country:US
Practice Address - Phone:917-710-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021896-1225100000X
CT010948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist