Provider Demographics
NPI:1578180527
Name:GRIFFIN, LAURA BETHANY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BETHANY
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 AWALT DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-3800
Mailing Address - Country:US
Mailing Address - Phone:931-247-2964
Mailing Address - Fax:
Practice Address - Street 1:835 UNION ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2607
Practice Address - Country:US
Practice Address - Phone:931-680-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5195225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant