Provider Demographics
NPI:1609345735
Name:GRASSER-HEMER, RILEY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:GRASSER-HEMER
Suffix:
Gender:M
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 1:727 75TH ST
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-5307
Mailing Address - Country:US
Mailing Address - Phone:715-554-1780
Mailing Address - Fax:
Practice Address - Street 1:1000 W 140TH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4833
Practice Address - Country:US
Practice Address - Phone:952-808-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN34372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program