Leonard A Grieco, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT000355E Issued in PA

Practice address

Trac Rehab Peach
5100 Peach Street
Erie, PA 16509

Phone

(814) 864-5097

Fax

(814) 864-9583

NPI assigned

Jul 14, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210032000000",
    "number": "1720086549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 STATE ST",
            "address_2": "SUITE 16,LL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011341",
            "telephone_number": "814-480-7100",
            "fax_number": "814-480-7604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TRAC REHAB PEACH",
            "address_2": "5100 PEACH STREET",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "16509",
            "telephone_number": "814-864-5097",
            "fax_number": "814-864-9583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIECO",
        "first_name": "LEONARD",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2008-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT000355E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016785750006",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3110682",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00025600602",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "669114",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00111335",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Erie, PA
• Providers in Erie, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.