MEDICARE: MRS. AMY LEIGH GRIZZLE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	004495	KY

General Provider Information

NPI Number	:	1427084730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LEIGH GRIZZLE PT

Provider Business Mailing Address
First Line	:	1302 AMBRIDGE DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-2410
Country	:	US
Telephone Number	:	502-897-1310
Fax Number	:

Provider Business Practice Location Address
First Line	:	9368 CEDAR CENTER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4522
Country	:	US
Telephone Number	:	502-231-3979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	06/28/2011

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