Provider Demographics
NPI:1164670014
Name:GREN, DEBRA LINN (PTA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LINN
Last Name:GREN
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 1:745 WATER TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2135
Mailing Address - Country:US
Mailing Address - Phone:231-592-1061
Mailing Address - Fax:231-592-5139
Practice Address - Street 1:745 WATER TOWER RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2135
Practice Address - Country:US
Practice Address - Phone:231-592-1061
Practice Address - Fax:231-592-5139
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant