Provider Demographics
NPI:1730754029
Name:GRIFFITH, CROMWELL LUKE STULL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CROMWELL
Middle Name:LUKE STULL
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:1570 HOLCOMB BRIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4715
Practice Address - Country:US
Practice Address - Phone:678-619-0003
Practice Address - Fax:678-619-0004
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty