Provider Demographics
NPI:1992339402
Name:GRIEDER, DAWN (LMT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GRIEDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1925
Mailing Address - Country:US
Mailing Address - Phone:973-835-5930
Mailing Address - Fax:
Practice Address - Street 1:435 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1925
Practice Address - Country:US
Practice Address - Phone:973-835-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01339000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist