Healthcare Provider Details

I. General information

NPI: 1598930505
Provider Name (Legal Business Name): ANDRE MARIUS GRIGGS L.P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE REHAB 146
MIAMI FL
33136-1005
US

IV. Provider business mailing address

10395 SW 210TH TER
CUTLER BAY FL
33189-3678
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6334
  • Fax:
Mailing address:
  • Phone: 786-355-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number21157
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: