Provider Demographics
NPI:1194211193
Name:GRISI, JULIE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GRISI
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5225
Mailing Address - Country:US
Mailing Address - Phone:610-797-4107
Mailing Address - Fax:
Practice Address - Street 1:500 E MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5225
Practice Address - Country:US
Practice Address - Phone:610-797-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0060882081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine