Provider Demographics
NPI:1386935047
Name:GRIFFIN, AMANDA LEIGH (PT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:BRIZENDINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:27 NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4109
Mailing Address - Country:US
Mailing Address - Phone:732-778-7908
Mailing Address - Fax:
Practice Address - Street 1:350 MAIN ST
Practice Address - Street 2:1ST FLOOR, COMMENCE PLACE
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5089
Practice Address - Country:US
Practice Address - Phone:781-321-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist