Provider Demographics
NPI:1306643598
Name:GRASMERE PHYSICAL THERAPY WELLNESS, PLLC
Entity type:Organization
Organization Name:GRASMERE PHYSICAL THERAPY WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TSERLYUK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-442-1003
Mailing Address - Street 1:1130 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3623
Mailing Address - Country:US
Mailing Address - Phone:718-442-1003
Mailing Address - Fax:718-442-1150
Practice Address - Street 1:1130 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3623
Practice Address - Country:US
Practice Address - Phone:718-442-1003
Practice Address - Fax:718-442-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1215507579OtherNPI
NY1568235760OtherNPI