Provider Demographics
NPI:1417076183
Name:GRINMANIS, DAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:GRINMANIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 OLEANDER LN NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8782
Mailing Address - Country:US
Mailing Address - Phone:321-213-5761
Mailing Address - Fax:
Practice Address - Street 1:307 E NEW HAVEN AVE
Practice Address - Street 2:SUITE
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4576
Practice Address - Country:US
Practice Address - Phone:321-953-3991
Practice Address - Fax:321-953-3951
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18877225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant