Provider Demographics
NPI:1326801747
Name:GRAYHAVEN PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GRAYHAVEN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CBS
Authorized Official - Phone:606-315-3003
Mailing Address - Street 1:128 RIGSBEES RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-8832
Mailing Address - Country:US
Mailing Address - Phone:606-315-3003
Mailing Address - Fax:
Practice Address - Street 1:128 RIGSBEES RD
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-8832
Practice Address - Country:US
Practice Address - Phone:606-315-3003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency