Individual
MR. CHARLES GRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
2151 WAUKEGAN RD, STE 130, BANNOCKBURN, IL 60015-1868
(847) 444-1321
Mailing address
6744 ROANOAKE CT, GURNEE, IL 60031-4011
(847) 650-1927
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070025959
IL
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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