Provider Demographics
NPI:1689179699
Name:GRAWBURG, JOAN CAROL (BS PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:CAROL
Last Name:GRAWBURG
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:CAROL
Other - Last Name:SONGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11227 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2614
Mailing Address - Country:US
Mailing Address - Phone:248-842-3072
Mailing Address - Fax:
Practice Address - Street 1:14900 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2251
Practice Address - Country:US
Practice Address - Phone:586-247-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist