Healthcare Provider Details

I. General information

NPI: 1821208034
Provider Name (Legal Business Name): MICHELLE MARIE GRILL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 FREEPORT RD 200 BUILDING SUITE 4000
PITTSBURGH PA
15215-3301
US

IV. Provider business mailing address

542 CRESTHAVEN DR
PITTSBURGH PA
15239-3608
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-5010
  • Fax:
Mailing address:
  • Phone: 412-656-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE007395
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: