Provider Demographics
NPI:1275568743
Name:GRICE, EDWIN PRICE III (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:PRICE
Last Name:GRICE
Suffix:III
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MCQUEEN SMITH RD N
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7511
Mailing Address - Country:US
Mailing Address - Phone:334-358-2201
Mailing Address - Fax:334-358-2236
Practice Address - Street 1:640 MCQUEEN SMITH RD N
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7511
Practice Address - Country:US
Practice Address - Phone:334-358-2201
Practice Address - Fax:334-358-2236
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPT1534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515426OtherBLUE CROSS BLUE SHIELD
ALR63294Medicare UPIN