Provider Demographics
NPI:1265435192
Name:GRIGSBY, JOHN DAVID (MPT, CERT MDT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:GRIGSBY
Suffix:
Gender:M
Credentials:MPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1708
Mailing Address - Country:US
Mailing Address - Phone:901-522-6671
Mailing Address - Fax:901-522-6715
Practice Address - Street 1:7730 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1708
Practice Address - Country:US
Practice Address - Phone:901-522-6671
Practice Address - Fax:901-522-6715
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPT6639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4042227OtherBLUE CROSS
MS620819926OtherBCBS
TN0723280001OtherPALMETTO
TN7753371OtherAETNA
TN4042227OtherBLUE CROSS