Provider Demographics
NPI:1164293239
Name:RAVAL, GRISHMA (PTA)
Entity Type:Individual
Prefix:
First Name:GRISHMA
Middle Name:
Last Name:RAVAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 FORD RD # 51
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-1474
Mailing Address - Country:US
Mailing Address - Phone:267-575-6966
Mailing Address - Fax:
Practice Address - Street 1:3000 FORD RD # 51
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-1474
Practice Address - Country:US
Practice Address - Phone:267-575-6966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013951225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant