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General NPI Number Information
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NPI Number | 1669835187
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Entity Type | Individual
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Provider Name | CAROL SUSAN GRIFFITH I P.T.A.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 4210 SABANA GRANDE AVE SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-1152
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Country | US
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Telephone | 505-816-7534
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 HUNTINGTON DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3040
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Country | US
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Telephone | 505-275-9174
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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 | A-0922
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License Number State | NM
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