Provider Demographics
NPI:1588062442
Name:GRUENDL, ASHLEY BERLEEN (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BERLEEN
Last Name:GRUENDL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SHARENE LN
Mailing Address - Street 2:APT 204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4776
Mailing Address - Country:US
Mailing Address - Phone:951-204-3504
Mailing Address - Fax:
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:SUITE 212
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3067
Practice Address - Country:US
Practice Address - Phone:925-939-8710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist