Healthcare Provider Details

I. General information

NPI: 1609231265
Provider Name (Legal Business Name): MEGAN GRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CHARLEVOIX DR SE STE 200
GRAND RAPIDS MI
49546-7086
US

IV. Provider business mailing address

8612 NEW HAVEN WAY
CANTON MI
48187-8214
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-5000
  • Fax:
Mailing address:
  • Phone: 734-679-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: