Individual
GRANT MICHAEL THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
120 WHITE ROSE DR, RACELAND, LA 70394-2644
(985) 532-9662
(985) 532-3942
Mailing address
6397 LEE HWY STE 300, CHATTANOOGA, TN 37421-2564
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1302513
TX
225100000X
Physical Therapist
Primary
PT09868
LA
Other
Enumeration date
10/11/2018
Last updated
10/11/2018
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