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General NPI Number Information
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NPI Number | 1467548974
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Entity Type | Individual
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Provider Name | MRS. STEPHANIE JO GRINSTEAD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1712 HOLTON ROAD SUITE B
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City | MUSKEGON
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State | MI
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Zip | 49445
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Country | US
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Telephone | 231-719-1921
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Fax | 231-719-9470
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Provider Business Mailing Address
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Address Line | 1712 HOLTON ROAD SUITE B
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City | MUSKEGON
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State | MI
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Zip | 49445
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Country | US
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Telephone | 231-719-1921
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Fax | 231-719-9470
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | DIPLOMA ONLY
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License Number State | MI
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