Most Relevant Information
Provider Data
| NPI Number: | 1003457300 |
| Provider Name: | DANIETA KAY GRISSMAN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2047777 |
Most Important Dates
| Enumeration Date: | 10/08/2019 |
| Last Updated: | 08/17/2020 |
Provider Practice Location
12460 WOODS EDGE TRL
FORT WORTH
TX
762449408
Practice Location Phone/Fax
| Phone: | 8176370368 |
| Fax: |
Provider Mailing Location
12460 WOODS EDGE TRL
FORT WORTH
TX
762449408
Provider Mailing Phone/Fax
| Phone: | 8176370368 |
| Fax: |