Healthcare Provider Details

I. General information

NPI: 1225968639
Provider Name (Legal Business Name): LAUREN GRISMER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 5TH AVE STE 100
SAN DIEGO CA
92103-3108
US

IV. Provider business mailing address

3644 SHOSHONI CT
COLLEGE STATION TX
77845-4587
US

V. Phone/Fax

Practice location:
  • Phone: 619-238-4318
  • Fax:
Mailing address:
  • Phone: 707-478-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: