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General NPI Number Information
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NPI Number | 1578118618
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Entity Type | Individual
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Provider Name | ETHAN GRANT MD
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Gender | Male
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2261 PHILADELPHIA DR STE 300
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City | DAYTON
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State | OH
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Zip | 45406-1814
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Country | US
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Telephone | 937-734-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 2261 PHILADELPHIA DR STE 300
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City | DAYTON
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State | OH
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Zip | 45406-1814
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Country | US
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Telephone | 937-734-4141
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT016847
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 57.259284
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License Number State | OH
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