Provider Demographics
NPI:1932307741
Name:MCGRIFF, ERIC JUSTIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JUSTIN
Last Name:MCGRIFF
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 MOSSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4550
Mailing Address - Country:US
Mailing Address - Phone:270-303-9761
Mailing Address - Fax:
Practice Address - Street 1:309 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BOILING SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37150-2149
Practice Address - Country:US
Practice Address - Phone:270-303-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPTA-A01728225200000X
TN4363225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant