Provider Demographics
NPI:1497706501
Name:GRIECO, PETER (DPT, MS, CSCS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GRIECO
Suffix:
Gender:M
Credentials:DPT, MS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTHDOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2538
Mailing Address - Country:US
Mailing Address - Phone:631-425-1110
Mailing Address - Fax:631-425-1115
Practice Address - Street 1:21 SOUTHDOWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2538
Practice Address - Country:US
Practice Address - Phone:631-425-1110
Practice Address - Fax:631-425-1115
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0277471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist