Healthcare Provider Details

I. General information

NPI: 1396361036
Provider Name (Legal Business Name): JAELYNN GRIESS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MAUI LANI PKWY
WAILUKU HI
96793-2467
US

IV. Provider business mailing address

1629 W AVALANCHE RD
LINCOLN NE
68521-1698
US

V. Phone/Fax

Practice location:
  • Phone: 808-446-2032
  • Fax:
Mailing address:
  • Phone: 402-310-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6297
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: