Healthcare Provider Details

I. General information

NPI: 1003956798
Provider Name (Legal Business Name): NANCY NOELLE GRIEGER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20701 CEREAL ST SKYDIVE ELSINORE, TEAM ROOM 8
LAKE ELSINORE CA
92530-9253
US

IV. Provider business mailing address

20701 CEREAL ST SKYDIVE ELSINORE, TEAM ROOM 8
LAKE ELSINORE CA
92530
US

V. Phone/Fax

Practice location:
  • Phone: 702-904-0178
  • Fax:
Mailing address:
  • Phone: 702-904-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1656
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE156417
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40167
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT40167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: