Healthcare Provider Details

I. General information

NPI: 1366391039
Provider Name (Legal Business Name): HALEY GRANT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 N 15TH AVE
PHOENIX AZ
85007-1201
US

IV. Provider business mailing address

14041 N 38TH ST
PHOENIX AZ
85032-5766
US

V. Phone/Fax

Practice location:
  • Phone: 602-362-6223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberLPT-034597
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: