| Doctor Name: | MR. PAUL L GRUMBACK |
| NPI Number: | 1588653687 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT LAC |
| License Number: | 0059051 |
| Business Practice Address: | 167 Acre Ln Hicksville, NY - 118014442 |
| Business Phone Number: | 5169323286 |
| Business Fax Number: | 5169320669 |
| Mailing Address: | 167 Acre Ln, HICKSVILLE |
| State: | NY |
| Postal Code: | 118014442 |
| Phone Number: | 5169323286 |
| Fax Number: | 5169320669 |
| NPI Enumeration Date: | 10/20/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0059051 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |