Provider Demographics
NPI:1043084635
Name:GRIT PERFORMANCE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:GRIT PERFORMANCE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:916-693-1837
Mailing Address - Street 1:12201 ENCANTO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-6791
Mailing Address - Country:US
Mailing Address - Phone:916-693-1837
Mailing Address - Fax:
Practice Address - Street 1:10398 ROCKINGHAM DR STE 9
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2507
Practice Address - Country:US
Practice Address - Phone:916-693-1837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty