MEDICARE: MR. PATRICK ERVIN GRISSETT JR. N/A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1194521401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK ERVIN GRISSETT JR. N/A

Provider Business Mailing Address
First Line	:	PO BOX 25253
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-0253
Country	:	US
Telephone Number	:	980-938-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	5551 GRASMERE AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3441
Country	:	US
Telephone Number	:	216-389-0905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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