Provider Demographics
NPI:1972554681
Name:GRISMER, CHRISTOPHER P (PHD, PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:GRISMER
Suffix:
Gender:M
Credentials:PHD, PT
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 727
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56502-0727
Mailing Address - Country:US
Mailing Address - Phone:218-844-2300
Mailing Address - Fax:218-844-2444
Practice Address - Street 1:125 FRAZEE ST E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3501
Practice Address - Country:US
Practice Address - Phone:218-844-2300
Practice Address - Fax:218-844-2444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist