Individual
GRANT DAVIS MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MOTR/L
Contact information
Practice address
1412 IOWA AVE W, FALCON HEIGHTS, MN 55108-2124
(218) 407-0820
Mailing address
1412 IOWA AVE W, FALCON HEIGHTS, MN 55108-2124
(218) 407-0820
Taxonomy
Speciality
Code
Description
License number
State
273Y00000X
Rehabilitation Hospital Unit
Primary
105222
—
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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