Provider Demographics
NPI:1225413073
Name:GRISSOM, HANNAH (LMT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:GRISSOM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:BRINTNALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:11591 NORTHLAND DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8426
Mailing Address - Country:US
Mailing Address - Phone:616-439-0199
Mailing Address - Fax:
Practice Address - Street 1:11591 NORTHLAND DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8426
Practice Address - Country:US
Practice Address - Phone:616-439-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007378225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist