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General NPI Number Information
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NPI Number | 1235949009
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Entity Type | Individual
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Provider Name | MATTHEW FRANCIS GRUSE MS, ACSM CEP
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Gender | Male
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 4646 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-1916
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Country | US
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Telephone | 313-576-1942
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Fax |
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Provider Business Mailing Address
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Address Line | 16920 RUDGATE ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-3348
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Country | US
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Telephone | 734-512-9774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Y00000X
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Taxonomy Name | Clinical Exercise Physiologist
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License Number |
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License Number State | MI
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