Healthcare Provider Details

I. General information

NPI: 1336487008
Provider Name (Legal Business Name): CHRISTOPHER JOHN GRINK MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 STACIE DR
HAZLETON PA
18201-5690
US

IV. Provider business mailing address

1000 STACIE DR
HAZLETON PA
18201-5690
US

V. Phone/Fax

Practice location:
  • Phone: 570-453-5191
  • Fax: 570-453-5190
Mailing address:
  • Phone: 570-453-5191
  • Fax: 570-453-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010335L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: