Provider Demographics
NPI:1497716955
Name:GRUNDMAN, DONNA MUIR (DSC PT, MS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MUIR
Last Name:GRUNDMAN
Suffix:
Gender:F
Credentials:DSC PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-1019
Mailing Address - Country:US
Mailing Address - Phone:810-434-1796
Mailing Address - Fax:
Practice Address - Street 1:940 RIVER CENTRE DR
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-4463
Practice Address - Country:US
Practice Address - Phone:810-985-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist