| Organization Name: | TRI STATE SPORTS MEDICINE AND REHABILITAION, INC |
| NPI Number: | 1265649594 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONNE PAUL GRIGSBY (OWNER) |
| Mailing Address: | 2004 Cumberland Ave Suite 300 Middlesboro |
| State: | KY US |
| Postal Code: | 409652829 |
| Phone Number: | 6062481996 |
| Fax Number: | |
| NPI Enumeration Date: | 05/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 4863 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |