Individual
JUSTIN WILLIAM GRIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
300 LIFE CARE LN, CARROLLTON, MO 64633-1861
(660) 542-0155
Mailing address
27175 PVT 275, CARROLLTON, MO 64633-6416
(660) 542-1713
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
112884
MO
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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