Healthcare Provider Details

I. General information

NPI: 1770504540
Provider Name (Legal Business Name): GRANT WILLIAM FOLEY P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 LAVENDER LN
GREENWOOD IN
46143-6234
US

IV. Provider business mailing address

1570 LAVENDER LN
GREENWOOD IN
46143-6234
US

V. Phone/Fax

Practice location:
  • Phone: 317-908-7307
  • Fax:
Mailing address:
  • Phone: 317-908-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002308A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: