Provider Demographics
NPI:1932871902
Name:GRINER, EMILY (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GRINER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E FIELDSTONE CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2190
Mailing Address - Country:US
Mailing Address - Phone:630-390-6560
Mailing Address - Fax:
Practice Address - Street 1:1300 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4415
Practice Address - Country:US
Practice Address - Phone:414-228-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant