Provider Demographics
NPI:1568739621
Name:GRIGAS, ANTHONY P (PT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:GRIGAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-2414
Mailing Address - Country:US
Mailing Address - Phone:570-868-3203
Mailing Address - Fax:570-868-3203
Practice Address - Street 1:220 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1137
Practice Address - Country:US
Practice Address - Phone:570-824-3444
Practice Address - Fax:570-824-4021
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008952L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA394508OtherMEDICARE