Provider Demographics
NPI:1841174588
Name:LEWALLEN, GRIFFIN KEITH (PT)
Entity type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:KEITH
Last Name:LEWALLEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4306
Mailing Address - Country:US
Mailing Address - Phone:256-539-2728
Mailing Address - Fax:256-704-0915
Practice Address - Street 1:13596 HIGHWAY 231 431 N STE 7
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8618
Practice Address - Country:US
Practice Address - Phone:256-539-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH12322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist