Individual
GRANT MICHAEL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1610 DRY CREEK DR, LONGMONT, CO 80503-6405
(720) 494-4750
(720) 494-4751
Mailing address
1610 DRY CREEK DR, LONGMONT, CO 80503-6405
(720) 494-4750
(720) 494-4751
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL.0017868
CO
Other
Enumeration date
08/20/2021
Last updated
09/16/2024
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