Healthcare Provider Details

I. General information

NPI: 1578505517
Provider Name (Legal Business Name): JOHN R GRABILL P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 FAIRLANE DR
VANCEBURG KY
41179-8975
US

IV. Provider business mailing address

PO BOX 600
VANCEBURG KY
41179-0600
US

V. Phone/Fax

Practice location:
  • Phone: 606-796-5000
  • Fax: 606-796-5001
Mailing address:
  • Phone: 606-796-2500
  • Fax: 606-796-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003827
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: