Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5835 | TN |
NPI | 1003407123 |
---|---|
Provider Name | William Winter Griffin |
First Address | Mount Juliet, TN 37122-5628 |
Second Address | Lebanon, TN 37090-0794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 01/02/2021 |