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NPI Code Detail

MEDICARE: KIMBERLY MICHELL GRIEST PTA

MEDICARE:   KIMBERLY MICHELL GRIEST  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant0003787OH

General Provider Information

NPI Number : 1528461282
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MICHELL GRIEST PTA
Provider Business Mailing Address
First Line : 25 W PLEASANT ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45506-2278
Country : US
Telephone Number : 937-325-7671
Fax Number :
Provider Business Practice Location Address
First Line : 1500 W JEFFERSON ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45506-1224
Country : US
Telephone Number : 937-505-4170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2014
Last Update Date : 10/08/2014

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Directions to “ KIMBERLY MICHELL GRIEST PTA” Practice Location

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