Healthcare Provider Details

I. General information

NPI: 1710448568
Provider Name (Legal Business Name): EMILY LYNN GRIESHABER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 VILLAGE CENTER BLVD STE 200
MYRTLE BEACH SC
29579-6706
US

IV. Provider business mailing address

210 VILLAGE CENTER BLVD STE 140
MYRTLE BEACH SC
29579-6706
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax: 843-353-3461
Mailing address:
  • Phone: 843-353-3460
  • Fax: 843-353-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12168
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP048778T
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ060279
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier1710448568
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: