Healthcare Provider Details

I. General information

NPI: 1568139475
Provider Name (Legal Business Name): GRIFFIN WERTH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 VILLA MADONNA DR
CRESTVIEW HILLS KY
41017
US

IV. Provider business mailing address

2328 WILLOW LN APT 109
FT MITCHELL KY
41017-1932
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-4060
  • Fax:
Mailing address:
  • Phone: 248-802-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: