Domingo Grullon Jr., DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA02192500 Issued in NY

Practice address

11275 Delaware Pkwy Ste B
Crown Point, IN 46307-7812

Phone

(219) 663-8766

NPI assigned

Aug 9, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, IN2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  • Physical Therapist
  • Peru, IN
  • NPI 1750764494
  Medicare reassignment NPD
• Multicare Health System

  • Neurological Surgery Physician
  • Tacoma, WA
  • NPI 1497766638
  Medicare reassignment NPD
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD
• Multicare Health System

  • Family Medicine Physician
  • Covington, WA
  • NPI 1093768657

  Physical Therapist

  NPD
• Multicare Health System

  • Community/Retail Pharmacy
  • Spokane, WA
  • NPI 1396594875
  NPD
• Multicare Health System

  • Family Medicine Physician
  • Auburn, WA
  • NPI 1013969195

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1720761570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 TACOMA MALL BLVD STE 300",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984096828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11275 DELAWARE PKWY STE B",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077812",
            "telephone_number": "219-663-8766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19321 Mountain Hwy E Ste 100",
            "address_purpose": "LOCATION",
            "city": "Spanaway",
            "state": "WA",
            "postal_code": "983878450",
            "country_code": "US",
            "telephone_number": "253-846-8918",
            "fax_number": "253-846-8126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10787 Randolph St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Winfield",
            "state": "IN",
            "postal_code": "463077615",
            "country_code": "US",
            "telephone_number": "219-333-5900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2502 Calumet Ave",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463832762",
            "country_code": "US",
            "telephone_number": "219-280-2034",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3319 Willowcreek Rd",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "IN",
            "postal_code": "463685015",
            "country_code": "US",
            "telephone_number": "574-544-5434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRULLON",
        "first_name": "DOMINGO",
        "name_suffix": "Jr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-09",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "40QA02192500",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP035073T",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte Ann Griffith, COTA
• Samantha Grigus
• Megan Groen, PA-C
• Laura Faythe Groot
• Grounded Therapy LLC
• Lindsay Grzymski, MS, CF-SLP
• Rafael Madayag Guanzon, OTR
• Nicole K Guido, MSW, LSW
• Jennifer Elizabeth Guillen, DPT, ATC/L, CSCS
• Evalisa Gutierrez

• Physical Therapist in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.