MEDICARE: MRS. KARISSA DANIELLE GRIBBIN PT, DPT

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	2255A2300X	Athletic Trainer	0506298	NV
2	225100000X	Physical Therapist	4935	NV

General Provider Information

NPI Number	:	1255877924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARISSA DANIELLE GRIBBIN PT, DPT

Provider Business Mailing Address
First Line	:	9070 W CHEYENNE AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8935
Country	:	US
Telephone Number	:	702-818-5000
Fax Number	:	702-818-5001

Provider Business Practice Location Address
First Line	:	6785 W RUSSELL RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1862
Country	:	US
Telephone Number	:	702-818-5000
Fax Number	:	702-818-5001

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	03/10/2025

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