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General NPI Number Information
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NPI Number | 1023350865
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Entity Type | Individual
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Provider Name | DAMON JOHN GRANDY PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 3117 STILLWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7164
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Country | US
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Telephone | 928-442-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 7159 S 233RD AVE
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City | BUCKEYE
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State | AZ
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Zip | 85326-8736
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Country | US
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Telephone | 417-298-2372
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9200
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2009024412
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH6368
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3588
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License Number State | HI
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-3025
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License Number State | ID
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Taxonomy #6
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1455
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License Number State | WY
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4147
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License Number State | NM
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