Provider Demographics
NPI:1780073601
Name:GRIFFIN, TAYLOR (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 OLD COUNTY HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-5612
Mailing Address - Country:US
Mailing Address - Phone:615-483-4707
Mailing Address - Fax:
Practice Address - Street 1:1390 OLD COUNTY HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:TN
Practice Address - Zip Code:37036-5612
Practice Address - Country:US
Practice Address - Phone:615-483-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1253800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1253800OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS- PHYSICAL THERAPY LICENSE