Provider Demographics
NPI:1801023866
Name:GROSSO, CAROL SAMUELS (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SAMUELS
Last Name:GROSSO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WAKEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4443
Mailing Address - Country:US
Mailing Address - Phone:917-544-5825
Mailing Address - Fax:
Practice Address - Street 1:56 WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4443
Practice Address - Country:US
Practice Address - Phone:917-544-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203112251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics