Provider Demographics
NPI:1366480212
Name:GRIFFITH, DAVID BROCK (MPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BROCK
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 2ND ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8524
Mailing Address - Country:US
Mailing Address - Phone:941-951-0170
Mailing Address - Fax:941-993-1088
Practice Address - Street 1:1727 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8524
Practice Address - Country:US
Practice Address - Phone:941-951-0170
Practice Address - Fax:941-993-1088
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016735225100000X
DEJ1-0001822225100000X
FL26300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000051057OtherDPCI
DE1366480212Medicaid
PA2135023OtherHIGHMARK PA BLUE SHIELD
DE3744641000OtherIBC
G02348D12OtherMEDICARE
P00359628OtherRAILROAD MEDICARE
PA1204047380001Medicaid
DE1366480212Medicaid