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General NPI Number Information
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NPI Number | 1649399700
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Entity Type | Individual
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Provider Name | AMANDA AYER GRANT DPT
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 252 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5137
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Country | US
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Telephone | 904-829-3411
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 GRANDE VISTA BLVD APT 204
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-1345
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Country | US
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Telephone | 904-829-3868
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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 | PT23148
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License Number State | FL
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