Provider Demographics
NPI:1679576003
Name:GRIESSER, KATHERINE JANE (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JANE
Last Name:GRIESSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 SKYDIVE DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6605
Mailing Address - Country:US
Mailing Address - Phone:910-797-3855
Mailing Address - Fax:910-904-5858
Practice Address - Street 1:405 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3411
Practice Address - Country:US
Practice Address - Phone:910-263-7438
Practice Address - Fax:910-904-5858
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2506991AOtherMEDICARE PIN FOR 230179B (WHA)