Provider Demographics
NPI:1780829051
Name:GRAJO, MELISSA B (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:GRAJO
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 1:3475 GREYSTONE AVE
Mailing Address - Street 2:4F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2238
Mailing Address - Country:US
Mailing Address - Phone:646-737-3550
Mailing Address - Fax:
Practice Address - Street 1:2825 3RD AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4003
Practice Address - Country:US
Practice Address - Phone:718-401-3000
Practice Address - Fax:718-292-8610
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY022413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist