Individual
MRS. LAURA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
(662) 402-5997
Mailing address
PO BOX 900, MOUND BAYOU, MS 38762-0900
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
—
—
Other
Enumeration date
02/07/2019
Last updated
02/07/2019
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