Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40167 | CA |
N | 2251S0007X | Physical Therapist - Sports | 1656 | NV |
N | 2251S0007X | Physical Therapist - Sports | PT40167 | CA |
NPI | 1003956798 |
---|---|
Provider Name | Nancy Noelle Grieger |
First Address | Lake Elsinore, CA 92530 |
Second Address | Lake Elsinore, CA 92530-9253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 25/02/2021 |