Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | RT006088 | PA |
Y | 213ES0000X | Sports Medicine | RT006088 | PA |
NPI | 1194211193 |
---|---|
Provider Name | Julie Grisi |
First Address | Allentown, PA 18103-5225 |
Second Address | Allentown, PA 18103-5225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 03/07/2018 |