Provider Demographics
NPI:1265957690
Name:GRIFFITH, DARRYL NATHANIEL (MMT)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:NATHANIEL
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9871 BROCKINGTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3592
Mailing Address - Country:US
Mailing Address - Phone:501-838-4224
Mailing Address - Fax:
Practice Address - Street 1:9871 BROCKINGTON ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120
Practice Address - Country:US
Practice Address - Phone:501-838-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty