Individual
GARY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
870 MAIN ST, FAYETTE, MS 39069-5695
(601) 786-3401
(601) 786-3400
Mailing address
1870 PORTERS CHAPEL RD, VICKSBURG, MS 39180-5797
(601) 529-6750
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0750
MS
Other
Enumeration date
07/07/2022
Last updated
07/07/2022
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