Individual
MRS. AMY GABRIELLE GRIZZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
5050B VILLAGE SQUARE DR, PADUCAH, KY 42001-9499
(270) 443-0681
(270) 442-9748
Mailing address
74 MOHAWK LN, BENTON, KY 42025-6948
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
003235
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000578073
BLUE CROSS BLUE SHIELD
KY
Enumeration date
07/07/2005
Last updated
03/04/2010
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