Provider Demographics
NPI:1750637690
Name:GRONDSKI, ANNA B (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:B
Last Name:GRONDSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BISIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:927 WARREN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1423
Mailing Address - Country:US
Mailing Address - Phone:401-438-0905
Mailing Address - Fax:401-383-7946
Practice Address - Street 1:927 WARREN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1423
Practice Address - Country:US
Practice Address - Phone:401-438-0905
Practice Address - Fax:401-383-7946
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI002831801Medicare PIN