MEDICARE: DAVID MAURICE GRIFFIN LMT

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
1	225700000X	Massage Therapist	11433	SC

General Provider Information

NPI Number	:	1801662713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MAURICE GRIFFIN LMT

Provider Business Mailing Address
First Line	:	105 LINDEVON LN UNIT A
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6239
Country	:	US
Telephone Number	:	803-816-1163
Fax Number	:

Provider Business Practice Location Address
First Line	:	4357 FORT JACKSON BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-2145
Country	:	US
Telephone Number	:	803-816-1163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2023
Last Update Date	:	12/01/2023

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Directions to “ DAVID MAURICE GRIFFIN LMT” Practice Location

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