Provider Demographics
NPI:1083751093
Name:GRIENER, AMANDA KAY (MPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:GRIENER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 TRAVINO AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7369
Mailing Address - Country:US
Mailing Address - Phone:904-797-7310
Mailing Address - Fax:
Practice Address - Street 1:105 MARINER HEALTH WAY
Practice Address - Street 2:SUITE 213
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3251
Practice Address - Country:US
Practice Address - Phone:904-217-4259
Practice Address - Fax:904-217-4251
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY01L2OtherBCBS
FL891650100Medicaid
FLCK850ZMedicare PIN