Provider Demographics
NPI:1407248073
Name:GRIST, KATHRYN ALANE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ALANE
Last Name:GRIST
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:26106 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7502
Practice Address - Country:US
Practice Address - Phone:276-623-0274
Practice Address - Fax:237-662-3031
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212286225100000X
TN10870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist