Provider Demographics
NPI:1871992321
Name:GROMATZKY, RYANNE LEAH (DPT)
Entity type:Individual
Prefix:
First Name:RYANNE
Middle Name:LEAH
Last Name:GROMATZKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1250
Mailing Address - Country:US
Mailing Address - Phone:719-464-7525
Mailing Address - Fax:
Practice Address - Street 1:33 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1309
Practice Address - Country:US
Practice Address - Phone:719-464-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist