Justin William Grider, P.T.
Individual provider Active NPI Physical Therapist · Carrollton, MO
NPI 1245445840 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1245445840
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 112884 (MO)
- Practice address
- 300 Life Care LN
Carrollton, MO 64633-1861 - Phone
- (660) 542-0155
- NPI assigned
- May 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112884 | MO | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 112884 | MO | Yes |
Addresses
Primary practice location
300 Life Care LN
Carrollton, MO 64633-1861
Mailing address
27175 PVT 275
Carrollton, MO 64633-6416
Phone (660) 542-1713
Other providers in Carrollton, MO
- Bertrand Fontem
- Jordan Francis
- Arlene Capistrano Germann
- James Mitchell Germann
- Triniti Gibson
- Madeline Marie Grider
- HCC Network
- HCC of Carroll County LLC
- Amber Renee Hendrix
- Andrew Douglas Horine
All providers in Carrollton, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.