Individual provider Active NPI

Amy Gabrielle Grizzard, PHYSICAL THERAPIST

  • Physical Therapist
  • Paducah, KY
National Provider Identifier
1619974508
Registry record updated Mar 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
003235 Issued in KY
Practice address
5050B Village Square Dr
Paducah, KY 42001-9499
Phone
(270) 443-0681
Fax
(270) 442-9748
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 003235 KY Primary

Addresses

Primary practice location

5050B Village Square Dr
Paducah, KY 42001-9499

Mailing address

74 Mohawk LN
Benton, KY 42025-6948

Other identifiers 1

IdentifierTypeStateIssuer
000000578073OtherKYBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
003235KYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Atlas Physical Therapy LLC CurrentSince Apr 1, 2015 Accepting new patients
Biokinetics Inc. Physical Therapist Past Accepting new patients
Atlas Physical Therapy LLC Past Accepting new patients
Fibro Care Clinic, LLC Physical Therapist Past Accepting new patients
Biokinetics, Inc PastSince Aug 6, 2014 Accepting new patients

Locations

244 US Highway 68 E
Benton, KY 42025
Phone (270) 443-0681

1413 State Route 45 N
Mayfield, KY 42066
Phone (270) 247-9500

100 Kiana Ct
Apt A
Paducah, KY 42001
Phone (270) 408-2123

5050 Village Square Dr
Ste B
Paducah, KY 42001
Phone (270) 443-0681

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267660800000",
    "number": "1619974508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 MOHAWK LN",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420256948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050B VILLAGE SQUARE DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420019499",
            "telephone_number": "270-443-0681",
            "fax_number": "270-442-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIZZARD",
        "first_name": "AMY",
        "middle_name": "GABRIELLE",
        "name_prefix": "Mrs.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "003235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000578073",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.