Provider Demographics
NPI:1003407123
Name:GRIFFIN, WILLIAM WINTER (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WINTER
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 GREYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5628
Mailing Address - Country:US
Mailing Address - Phone:615-525-5264
Mailing Address - Fax:
Practice Address - Street 1:1001 MADDOX SIMPSON PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-0794
Practice Address - Country:US
Practice Address - Phone:615-525-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5835225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant