Individual
GRANT FALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2185 84TH ST SW, SUITE H, BYRON CENTER, MI 49315-8020
(616) 249-2924
Mailing address
2120 43RD ST SE, SUITE 100, GRAND RAPIDS, MI 49508-3772
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501017885
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501017885
STATE LICENSE
MI
Enumeration date
11/29/2016
Last updated
11/29/2016
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