Provider Demographics
NPI:1902949522
Name:GRIGALONIS, MICHAEL FRANCIS (ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:GRIGALONIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1610
Mailing Address - Country:US
Mailing Address - Phone:570-544-6738
Mailing Address - Fax:
Practice Address - Street 1:326 ROUTE 61 S
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-9706
Practice Address - Country:US
Practice Address - Phone:570-385-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002422A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer