Healthcare Provider Details

I. General information

NPI: 1912527573
Provider Name (Legal Business Name): MICHELLE ELISE GRZYBOWSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 WESLEY DR STE 141
MEMPHIS TN
38116-6443
US

IV. Provider business mailing address

1251 WESLEY DR STE 141
MEMPHIS TN
38116-6443
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-3726
  • Fax:
Mailing address:
  • Phone: 901-516-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12292
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: