Healthcare Provider Details

I. General information

NPI: 1932871902
Provider Name (Legal Business Name): EMILY GRINER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W SILVER SPRING DR
GLENDALE WI
53209-4415
US

IV. Provider business mailing address

115 E FIELDSTONE CIR APT 4
OAK CREEK WI
53154-2190
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-8120
  • Fax:
Mailing address:
  • Phone: 630-390-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: