Provider Demographics
NPI:1902942154
Name:GRIDER, REBECCA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:GRIDER
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 1:1075 BOILING SPGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2248
Mailing Address - Country:US
Mailing Address - Phone:864-580-2001
Mailing Address - Fax:864-580-2003
Practice Address - Street 1:1075 BOILING SPGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2248
Practice Address - Country:US
Practice Address - Phone:864-580-2001
Practice Address - Fax:864-580-2003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist