Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 6682A | AZ |
NPI | 1013279348 |
---|---|
Provider Name | Tara Griffin |
First Address | Mesa, AZ 85210-9518 |
Second Address | Mesa, AZ 85210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2012 |
Last Update Date | 13/11/2019 |