Individual provider Active NPI

Donald Vernon Grant

  • Physical Therapy Assistant
  • Gulf Breeze, FL
National Provider Identifier
1861781627
Registry record updated Apr 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA 20624 Issued in FL
Practice address
3428 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-1400
Phone
(850) 932-2655
NPI assigned
Apr 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA 20624 FL Primary

Addresses

Primary practice location

3428 Gulf Breeze Pkwy
Gulf Breeze, FL 32563-1400

Mailing address

8477 S Suncoast Blvd
Homosassa, FL 34446-5028
Phone (352) 382-1141

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA 20624FLMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301616000000",
    "number": "1861781627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8477 S SUNCOAST BLVD",
            "city": "HOMOSASSA",
            "state": "FL",
            "postal_code": "344465028",
            "telephone_number": "352-382-1141",
            "fax_number": "352-382-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3428 GULF BREEZE PKWY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325631400",
            "telephone_number": "850-932-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "DONALD",
        "middle_name": "VERNON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-01",
        "last_updated": "2011-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA 20624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulf Breeze, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.