Provider Demographics
NPI:1538766167
Name:GREWAL, AMIT (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:GREWAL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E SARATOGA ST STE 813
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3543
Mailing Address - Country:US
Mailing Address - Phone:813-541-1248
Mailing Address - Fax:
Practice Address - Street 1:222 E SARATOGA ST STE 813
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3543
Practice Address - Country:US
Practice Address - Phone:813-541-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014259208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation