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General NPI Number Information
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NPI Number | 1326551961
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Entity Type | Individual
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Provider Name | TEVIN GRIFFIN
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Gender | Male
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 301 E MIEL DE LUNA AVE
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City | TUCUMCARI
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State | NM
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Zip | 88401-3810
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Country | US
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Telephone | 575-461-7230
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Fax |
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Provider Business Mailing Address
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Address Line | 3908 N 110TH PLZ
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City | OMAHA
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State | NE
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Zip | 68164-2846
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Country | US
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Telephone | 402-452-7410
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1598
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA1459
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License Number State | NM
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