Provider Demographics
NPI:1184371254
Name:MARIANO, GRAND LLOYD PERELLO (RPT, MAED)
Entity type:Individual
Prefix:MR
First Name:GRAND LLOYD
Middle Name:PERELLO
Last Name:MARIANO
Suffix:
Gender:M
Credentials:RPT, MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 MARSHBANK DR
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1076
Mailing Address - Country:US
Mailing Address - Phone:248-462-2972
Mailing Address - Fax:
Practice Address - Street 1:1638 MARSHBANK DR
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1076
Practice Address - Country:US
Practice Address - Phone:248-462-2972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist