Provider Demographics
NPI:1154659670
Name:GRIGSBY, ERIN JOHNSON (PT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JOHNSON
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 TOWNE LAKE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8264
Mailing Address - Country:US
Mailing Address - Phone:678-445-9799
Mailing Address - Fax:678-445-2688
Practice Address - Street 1:1432 TOWNE LAKE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8264
Practice Address - Country:US
Practice Address - Phone:678-445-9799
Practice Address - Fax:678-445-2688
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist