Provider Demographics
NPI:1760419709
Name:GRUNZWEIG, JENNIFER (MS, LATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GRUNZWEIG
Suffix:
Gender:F
Credentials:MS, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 STUDIO RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2809
Mailing Address - Country:US
Mailing Address - Phone:617-558-7025
Mailing Address - Fax:
Practice Address - Street 1:106 CENTRAL ST
Practice Address - Street 2:KEOHANE SPORTS CENTER
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-8268
Practice Address - Country:US
Practice Address - Phone:781-283-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer