Provider Demographics
NPI:1013341577
Name:GRENZ, ASHLEY MARIE (MS, ATC, CA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MARIE
Last Name:GRENZ
Suffix:
Gender:F
Credentials:MS, ATC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31406 117TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57646-6402
Mailing Address - Country:US
Mailing Address - Phone:605-216-7411
Mailing Address - Fax:605-437-2508
Practice Address - Street 1:121 MAIN ST N
Practice Address - Street 2:
Practice Address - City:HERREID
Practice Address - State:SD
Practice Address - Zip Code:57632-2115
Practice Address - Country:US
Practice Address - Phone:605-437-2252
Practice Address - Fax:605-437-2508
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer