Individual
ETHAN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2261 PHILADELPHIA DR STE 300, DAYTON, OH 45406-1814
(937) 734-4141
Mailing address
2261 PHILADELPHIA DR STE 300, DAYTON, OH 45406-1814
(937) 734-4141
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
PT016847
OH
2251X0800X
Orthopedic Physical Therapist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
57.259284
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2019
Last updated
08/06/2025
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