Healthcare Provider Details

I. General information

NPI: 1235360884
Provider Name (Legal Business Name): JESSICA GRIFFIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 FOX RD SUITE NUMBER A
JONESBORO AR
72404-9322
US

IV. Provider business mailing address

2806 CANTERBURY
PARAGOULD AR
72450-5095
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9294
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA2322
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: