Tyesha Grissom, PT, DPT
Physical Therapist in Dallas, TX. Individual provider (NPI-1).
NPI number1366074932
StatusActive
Last updated in NPPESFeb 11, 2020
Details
- NPI
- 1366074932
- Entity type
- Individual (NPI-1)
- Name
- Tyesha Grissom
- Credential
- PT, DPT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Feb 11, 2020
- Certification date
- Feb 11, 2020
- Last updated
- Feb 11, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | PT009052 | GA | Yes |
| 225100000X | Physical Therapist | 1196223 | TX |
Practice location
8848 Greenville AveDallas, TX 75243-7143
Phone 877-293-6287
Mailing address
8848 Greenville AveDallas, TX 75243-7143
Phone 877-293-6287
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