Provider Demographics
NPI:1144771148
Name:GRISE, DAVID EDWARD (ATC, OTC, RT (R))
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:GRISE
Suffix:
Gender:M
Credentials:ATC, OTC, RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 W MALDONADO RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6371
Mailing Address - Country:US
Mailing Address - Phone:480-518-5552
Mailing Address - Fax:
Practice Address - Street 1:3136 W MALDONADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6371
Practice Address - Country:US
Practice Address - Phone:480-518-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography