Provider Demographics
NPI:1194521401
Name:GRISSETT, PATRICK ERVIN JR (N/A)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ERVIN
Last Name:GRISSETT
Suffix:JR
Gender:
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25253
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-0253
Mailing Address - Country:US
Mailing Address - Phone:980-938-9678
Mailing Address - Fax:
Practice Address - Street 1:5551 GRASMERE AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3441
Practice Address - Country:US
Practice Address - Phone:216-389-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach