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Individual
PHYLLIS GRIMMER EBERLINE
Active
Individual
PHYLLIS GRIMMER EBERLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT,DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305000880
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699037804
—
VA
01
—
2305000880
VIRGINIA STATE LICENSE
VA
01
—
C09695
GROUP MEDICARE P-TAN
VA
Enumeration date
06/13/2012
Last updated
05/07/2015
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