Provider Demographics
NPI:1922412055
Name:GRONOS, JEREMY (DPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:GRONOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600-A EAST MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141
Mailing Address - Country:US
Mailing Address - Phone:540-633-0413
Mailing Address - Fax:540-633-0416
Practice Address - Street 1:600-A EAST MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141
Practice Address - Country:US
Practice Address - Phone:540-633-0413
Practice Address - Fax:540-633-0416
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206615225100000X
GAPT011360225100000X
IL070018224225100000X
WAPT60290286225100000X
MI5501016344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist