Individual
MR. SCOTTY W. GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.P.T.
Contact information
Practice address
5250 GALAXIE DR, SUITE K, JACKSON, MS 39206-4311
(601) 368-4570
(601) 368-4571
Mailing address
5250 GALAXIE DR, SUITE K, JACKSON, MS 39206-4311
(601) 368-4570
(601) 368-4571
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3612
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT3612
PHYSICAL THERAPY LICENSE
MS
Enumeration date
10/19/2006
Last updated
07/08/2007
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