Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 05000 | LA |
Y | 225100000X | Physical Therapist | PT009012 | GA |
N | 2251G0304X | Physical Therapist - Geriatrics | 05000 | LA |
N | 2251S0007X | Physical Therapist - Sports | 05000 | LA |
N | 2251X0800X | Physical Therapist - Orthopedic | 05000 | LA |
NPI | 1518990746 |
---|---|
Provider Name | Ms. Ami Grigg |
First Address | Belle Chasse, LA 70037-3014 |
Second Address | New Orleans, LA 70130-3629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 24/03/2008 |