Provider Demographics
NPI:1710552559
Name:GRIFFITH, HEATH TAYLOR (DPT)
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:TAYLOR
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 MCINGVALE RD STE J
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8696
Mailing Address - Country:US
Mailing Address - Phone:662-548-2710
Mailing Address - Fax:662-548-2711
Practice Address - Street 1:2670 MCINGVALE RD STE J
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-8696
Practice Address - Country:US
Practice Address - Phone:662-548-2710
Practice Address - Fax:662-548-2711
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist