Provider Demographics
NPI:1780067728
Name:GRIEP, CARRIE MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MICHELLE
Last Name:GRIEP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3502
Mailing Address - Country:US
Mailing Address - Phone:619-422-0404
Mailing Address - Fax:619-422-4153
Practice Address - Street 1:320 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3502
Practice Address - Country:US
Practice Address - Phone:619-422-0404
Practice Address - Fax:619-422-4153
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425472251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42547OtherPHYSICAL THERAPY BOARD OF CALIFORNIA