Provider Demographics
NPI:1386868883
Name:GRIFFIN, LESA MCCONNELL (PT)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:MCCONNELL
Last Name:GRIFFIN
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 1:1295 HEMBREE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5721
Mailing Address - Country:US
Mailing Address - Phone:770-475-8364
Mailing Address - Fax:770-442-5444
Practice Address - Street 1:1295 HEMBREE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5721
Practice Address - Country:US
Practice Address - Phone:770-475-8364
Practice Address - Fax:770-442-5444
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist