Provider Demographics
NPI:1639346919
Name:GRAIL, WALTER RANDALL (RRT)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:RANDALL
Last Name:GRAIL
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:GRAIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRT
Mailing Address - Street 1:3001 MILBURN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5760
Mailing Address - Country:US
Mailing Address - Phone:970-640-7182
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6428
Practice Address - Country:US
Practice Address - Phone:970-263-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5812279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care