Provider Demographics
NPI:1740674597
Name:GRIFFIN, TOMMI RITA (PTA)
Entity type:Individual
Prefix:MRS
First Name:TOMMI
Middle Name:RITA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:TOMMI
Other - Middle Name:RITA
Other - Last Name:REIDENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:10400 75TH ST
Mailing Address - Street 2:MEDICAL CENTER
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7884
Mailing Address - Country:US
Mailing Address - Phone:262-948-3600
Mailing Address - Fax:
Practice Address - Street 1:10400 75TH ST
Practice Address - Street 2:MEDICAL CENTER
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7884
Practice Address - Country:US
Practice Address - Phone:262-948-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2255-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant