Provider Demographics
NPI:1538277371
Name:GRABLE, THOMAS J (ATC, PTA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:GRABLE
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3013
Mailing Address - Country:US
Mailing Address - Phone:908-272-6720
Mailing Address - Fax:
Practice Address - Street 1:511 MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3701
Practice Address - Country:US
Practice Address - Phone:973-361-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000606002255A2300X
NJ40QB00115800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant