Healthcare Provider Details

I. General information

NPI: 1255251005
Provider Name (Legal Business Name): GRAYSON ANDREW HORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 MIDLOTHIAN TPKE STE A
NORTH CHESTERFIELD VA
23235-4943
US

IV. Provider business mailing address

3214 E BROAD ST APT A
RICHMOND VA
23223-7558
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012534
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: