Individual
DETRIC GRIFFIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2191 ATTALA ROAD 1006, KOSCIUSKO, MS 39090-6146
(662) 739-1320
Mailing address
2191 ATTALA ROAD 1006, KOSCIUSKO, MS 39090-6146
(662) 739-1320
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5972
MS
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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