Provider Demographics
NPI:1366558447
Name:GRABOS, MADONNA L (PT)
Entity type:Individual
Prefix:
First Name:MADONNA
Middle Name:L
Last Name:GRABOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 S LAKE PARK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5961
Mailing Address - Country:US
Mailing Address - Phone:219-945-1538
Mailing Address - Fax:219-945-0151
Practice Address - Street 1:1265 S LAKE PARK AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5961
Practice Address - Country:US
Practice Address - Phone:219-945-1538
Practice Address - Fax:219-945-0151
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001448A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05001448AOtherBCBS OF IL
IN200467670Medicaid
IN000000306881OtherANTHEM
INP00128662Medicare PIN
IN216000AMedicare PIN