Provider Demographics
NPI:1356718241
Name:GRALAK, NICOLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:GRALAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1402
Mailing Address - Country:US
Mailing Address - Phone:814-486-7878
Mailing Address - Fax:814-486-7879
Practice Address - Street 1:416 N BROAD ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1402
Practice Address - Country:US
Practice Address - Phone:814-486-7878
Practice Address - Fax:814-486-7879
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist