Gary Grant
Individual provider Active NPI Physical Therapist · Fayette, MS
NPI 1295468239 · NPPES record last updated Jul 7, 2022
Key facts
- NPI
- 1295468239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 0750 (MS)
- Practice address
- 870 Main St
Fayette, MS 39069-5695 - Phone
- (601) 786-3401
- Fax
- (601) 786-3400
- NPI assigned
- Jul 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0750 | MS | MD | Physical Therapist |
Interoperability endpoints
- gary.grant.1@13136.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0750 | MS | Yes |
Addresses
Primary practice location
870 Main St
Fayette, MS 39069-5695
Mailing address
1870 Porters Chapel Rd
Vicksburg, MS 39180-5797
Phone (601) 529-6750
Other providers in Fayette, MS
- John Ellis Evans
- Evers Personal Care & Respite Services LLC
- Fayette Express Pharmacy
- Georgene Ferrie
- Golden Arms Assisted Living LLC
- Gloria W Gray
- Irving O Grayson Jr.
- Cashy Tiara Hammitte
- Harmony Hope Haven LLC
- Janecia Herrington
All providers in Fayette, MS · Physical Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.