Provider Demographics
NPI:1881726875
Name:GRAMBERG, LYNNE MARIE (PT, ATC, OCS)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:MARIE
Last Name:GRAMBERG
Suffix:
Gender:F
Credentials:PT, ATC, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 CADILLAC LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1306
Mailing Address - Country:US
Mailing Address - Phone:215-487-7811
Mailing Address - Fax:215-487-4328
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1737
Practice Address - Country:US
Practice Address - Phone:215-487-4718
Practice Address - Fax:215-487-4328
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008258L225100000X
PART000128A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer