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General NPI Number Information
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NPI Number | 1902790793
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Entity Type | Organization
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Legal Business Name | GRT PERFORMANCE LLC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 6040 TELETOWNE DR
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City | TOLEDO
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State | OH
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Zip | 43612-4603
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Country | US
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Telephone | 855-200-2478
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Fax | 734-799-8022
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Provider Business Mailing Address
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Address Line | 5646 KYLIE CT
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City | SYLVANIA
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State | OH
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Zip | 43560-9910
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Country | US
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Telephone | 419-466-0001
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Fax |
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Authorized Official
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Title or Position | MEDICAL PROVIDER
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Name | LORI JACOBS
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Credential | APRN
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Telephone | 855-200-2478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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