Breanna Latisha Grant, DPT
Individual provider Active NPI Physical Therapist · Jasper, TN
NPI 1831963172 · NPPES record last updated Sep 4, 2026
Key facts
- NPI
- 1831963172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- CP061919T (TN)
- Practice address
- 4150 Main St Ste 101
Jasper, TN 37347-3446 - Phone
- (423) 942-8073
- NPI assigned
- Nov 7, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 15
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Drayer Physical Therapy-South Carolina ,LLC
Tidewater Physical Therapy LLC
Practice addresses (Care Compare)
130 Forum Dr
Suite 13
Columbia, SC 29229-7943
Phone (803) 509-6880
2033 Colonial Ave SW
Suite 138
Roanoke, VA 24015-3210
Phone (540) 466-3981
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC, VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231214003328 | SC | Practitioner - Physical Therapist in Private Practice | 7113376229 | Reassigns benefits to 3 organizations |
| I20260225003824 | VA | Practitioner - Physical Therapist in Private Practice | 7113376229 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12126 | SC | MD | Cardiovascular Disease Physician |
| CP052818T | KY | MD | Physical Therapist |
| CP052818T | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benchmark Health Services | Physical Therapist | Current |
Accepting new patients |
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
| Benchmark Healthcare Services, LLC | Physical Therapist | Current |
Accepting new patients |
| Agilitas USA, Inc | Physical Therapist | Current |
Accepting new patients |
| Professional Sportscare & Rehab, LLC | Physical Therapist | Current |
Accepting new patients |
| Athletico, LTD | Physical Therapist | Current |
Accepting new patients |
| Drayer Physical Therapy - South Carolina, LLC | Physical Therapist | Current |
Accepting new patients |
| Agilitas USA Inc | Physical Therapist | Current |
Accepting new patients |
| Drayer Physical Therapy-South Carolina, LLC | Physical Therapist | Current |
Accepting new patients |
| Professional Sportscare & Rehab, LLC | Physical Therapist | Past | Accepting new patients |
Locations
1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568
2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250
130 Forum Dr
Ste 13
Columbia, SC 29229
Phone (803) 509-6880
1000 Tanner Ford Blvd
Ste 370
Hanahan, SC 29410
Phone (843) 718-1058
7585 Saint Andrews Rd
Irmo, SC 29063
Phone (803) 749-5031
3032 W Montague Ave
Ste 101
North Charleston, SC 29418
Phone (843) 885-8772
9512 Dorchester Rd
Ste 140
Summerville, SC 29485
Phone (843) 695-7970
11662 Sudley Manor Dr
#50B
Manassas, VA 20109
Phone (571) 321-5720
4625 Virginia Beach Blvd
Ste 103
Virginia Beach, VA 23462
Phone (757) 600-5999
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | CP052818T | VA | |
| Physical Therapist | 225100000X | CP052818T | KY | |
| Physical Therapist | 225100000X | 12126 | SC | |
| Physical Therapist | 225100000X | CP061919T | TN | Yes |
Addresses
Primary practice location
4150 Main St Ste 101
Jasper, TN 37347-3446
Mailing address
1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-8995
Other practice location 1
130 Forum Dr Ste 13
Columbia, SC 29229-7943
Phone (803) 509-6880
Other practice location 2
2033 Colonial Ave SW Ste 138
Roanoke, VA 24015-3210
Phone (540) 466-3981
Other providers in Jasper, TN
- Faramarz Ghanbari
- Glenna W. Lashley, LLC
- Abigail Elise Goncalves
- Grandview Cardiology, LLC
- Grandview Physician Group LLC
- Christy Green
- Melissa S Halley
- Brynna Chivaune Hamilton
- Karim D Hasnani
- Howell F Hathorne
All providers in Jasper, TN · Physical Therapist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.