Provider Demographics
NPI:1821023649
Name:GRIFFIN, ELAINE D (PT)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 THORNBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1391
Mailing Address - Country:US
Mailing Address - Phone:229-630-0254
Mailing Address - Fax:229-630-0254
Practice Address - Street 1:8033 OUSLEY RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-1011
Practice Address - Country:US
Practice Address - Phone:229-253-8415
Practice Address - Fax:229-249-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000567564CMedicaid