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General NPI Number Information
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NPI Number | 1275634594
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Entity Type | Individual
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Provider Name | GRIFFIN A EWALD PT
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 625 E SAINT PAUL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53202-5907
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Country | US
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Telephone | 414-272-9594
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Fax |
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone | 630-296-2223
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9928024
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License Number State | WI
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