Provider Demographics
NPI:1003956798
Name:GRIEGER, NANCY NOELLE (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NOELLE
Last Name:GRIEGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20701 CEREAL ST
Mailing Address - Street 2:SKYDIVE ELSINORE, TEAM ROOM 8
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530
Mailing Address - Country:US
Mailing Address - Phone:702-904-0178
Mailing Address - Fax:
Practice Address - Street 1:20701 CEREAL ST
Practice Address - Street 2:SKYDIVE ELSINORE, TEAM ROOM 8
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-9253
Practice Address - Country:US
Practice Address - Phone:702-904-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16562251S0007X
CAE156417146N00000X
CA40167225100000X
CAPT401672251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB250917Medicare PIN
CACB250918Medicare PIN
CAW17215AMedicare PIN
CAW17215Medicare PIN