Provider Demographics
NPI:1568632750
Name:GRYNBAUM, DANA KIMBERLY (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KIMBERLY
Last Name:GRYNBAUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3936
Mailing Address - Country:US
Mailing Address - Phone:954-478-4648
Mailing Address - Fax:954-748-4571
Practice Address - Street 1:2035 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-3936
Practice Address - Country:US
Practice Address - Phone:954-478-4648
Practice Address - Fax:954-748-4571
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist