Provider Demographics
NPI:1851067599
Name:GRYWINSKI, TERRENCE BRIAN (LICENSED MASSAGE THE)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:BRIAN
Last Name:GRYWINSKI
Suffix:
Gender:M
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 MEANDERING WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-1864
Mailing Address - Country:US
Mailing Address - Phone:941-321-8757
Mailing Address - Fax:
Practice Address - Street 1:1188 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2414
Practice Address - Country:US
Practice Address - Phone:941-321-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA6049172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist