Provider Demographics
NPI:1609997329
Name:GROGESKY, BRIAN EDWARD
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWARD
Last Name:GROGESKY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BRIAN
Other - Middle Name:EDWARD
Other - Last Name:GROGESKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,ATC
Mailing Address - Street 1:120 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9408
Mailing Address - Country:US
Mailing Address - Phone:610-370-9261
Mailing Address - Fax:
Practice Address - Street 1:700 PENN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1107
Practice Address - Country:US
Practice Address - Phone:610-898-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002082A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer