Provider Demographics
NPI:1548690779
Name:GRIDIRON 24-7
Entity type:Organization
Organization Name:GRIDIRON 24-7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-990-5558
Mailing Address - Street 1:PO BOX 1178
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-1178
Mailing Address - Country:US
Mailing Address - Phone:910-990-5558
Mailing Address - Fax:
Practice Address - Street 1:637 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-1813
Practice Address - Country:US
Practice Address - Phone:910-990-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty