Provider Demographics
NPI:1588815245
Name:GRISCTI, ANTHONY PAUL (LPTA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PAUL
Last Name:GRISCTI
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 AGUA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3706
Mailing Address - Country:US
Mailing Address - Phone:386-753-9982
Mailing Address - Fax:
Practice Address - Street 1:246 AGUA VISTA ST
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-3706
Practice Address - Country:US
Practice Address - Phone:386-753-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant