Basic Information
| Provider Information | |||||||||
| NPI: | 1437104163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREBNER | ||||||||
| FirstName: | AMBUR | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHENELLY | ||||||||
| OtherFirstName: | AMBUR | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 800 CARTER STREET | ||||||||
| Address2: | ATTN KELLY STEELE | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853394793 | ||||||||
| FaxNumber: | 5853364845 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 CARTER ST | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146212604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853381400 | ||||||||
| FaxNumber: | 5853364845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0272621 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 11514673 | 01 | NY | CAQH | OTHER | 00355266 | 05 | NY | MEDICAID | 5361 | 01 | NY | SIDNEY HILLMAN | OTHER | 2579671 | 01 | NY | UNITED HEALTH CARE | OTHER | P00357141 | 01 | NY | MEDICARE RAILROAD | OTHER | P0140059WH | 01 | NY | BLUE CHOICE | OTHER | FA0501 | 01 | NY | PREFERRED CARE | OTHER | 00027338501 | 01 | NY | UNIVERA | OTHER |