Healthcare Provider Details

I. General information

NPI: 1467789388
Provider Name (Legal Business Name): GRABILLS BODY SHOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
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: 606-796-5000
  • Fax: 606-796-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT003827
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN RICHARD GRABILL
Title or Position: OWNER/DIRECTOR
Credential: PT
Phone: 606-796-5000