Organization
BIOGENICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT WAYNE GRANTHAM MPT (OWNER/PHYSICAL THERAPIST)
(601) 906-3718
Entity
Organization
Contact information
Practice address
307 CHARTRESE DR, BRANDON, MS 39047-8779
(601) 906-3718
Mailing address
307 CHARTRESE DR, BRANDON, MS 39047-8779
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
PT3612
MS
Other
Enumeration date
05/19/2015
Last updated
05/19/2015
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