Provider Demographics
NPI:1831323666
Name:GRISHKA, RENNEE MICHELLE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:RENNEE
Middle Name:MICHELLE
Last Name:GRISHKA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 CRESTMONT CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8326
Mailing Address - Country:US
Mailing Address - Phone:614-870-8480
Mailing Address - Fax:
Practice Address - Street 1:581 CRESTMONT COURT
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119
Practice Address - Country:US
Practice Address - Phone:800-226-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist