Provider Demographics
NPI:1386711695
Name:GRINDLE, DAWN G (PT)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:G
Last Name:GRINDLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HILBURN RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-4223
Mailing Address - Country:US
Mailing Address - Phone:706-867-6127
Mailing Address - Fax:706-867-7965
Practice Address - Street 1:91 HILBURN RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-4223
Practice Address - Country:US
Practice Address - Phone:706-867-6127
Practice Address - Fax:706-867-7965
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10059732OtherAMERIGROUP PROVIDER #