Individual
DR. GRANT M HEADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., D.P.T.
Contact information
Practice address
1500 SW FIRST AVE STE 150, PORTLAND, OR 97201-5900
(503) 222-1955
(503) 222-1485
Mailing address
1500 SW FIRST AVE STE 150, PORTLAND, OR 97201-5900
(503) 222-1955
(503) 222-1485
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
60952
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760738652
NPI
OR
Enumeration date
09/06/2013
Last updated
09/30/2022
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