Healthcare Provider Details

I. General information

NPI: 1710811062
Provider Name (Legal Business Name): CARRIE ELIZABETH GRIERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MARIE LANGDON DRIVE
MANCHESTER KY
40962
US

IV. Provider business mailing address

319 CLARK DR
LONDON KY
40741-1573
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-5104
  • Fax:
Mailing address:
  • Phone: 606-682-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA01772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: