Provider Demographics
NPI:1649270570
Name:GRUENSFELDER, LISA GAIL (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:GRUENSFELDER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:33 WILLOW GLN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1341
Mailing Address - Country:US
Mailing Address - Phone:404-845-0023
Mailing Address - Fax:404-845-0079
Practice Address - Street 1:33 WILLOW GLN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1341
Practice Address - Country:US
Practice Address - Phone:404-845-0023
Practice Address - Fax:404-845-0079
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA6734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist