Provider Demographics
NPI:1093325193
Name:GRIBBLE, PHILLIP (ATC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:GRIBBLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CHARLES WETHINGTON BUILDING 900 SOUTH LIMESTONE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-218-0885
Mailing Address - Fax:
Practice Address - Street 1:210 CHARLES WETHINGTON BUILDING 900 SOUTH LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0200
Practice Address - Country:US
Practice Address - Phone:859-218-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT12002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer