Individual
TRACIE RENEE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1150 MARSH STREET, TAPPAHANNOCK, VA 22560
(804) 434-4308
Mailing address
4310 LAKEFIELD MEWS DR APT A, HENRICO, VA 23231-4159
(804) 397-8736
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306604644
VA
Other
Enumeration date
04/17/2019
Last updated
04/17/2019
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