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General NPI Number Information
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NPI Number | 1912409046
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Entity Type | Organization
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Legal Business Name | GRAND THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 1600 ATKINSON RD STE 111
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5747
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Country | US
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Telephone | 267-549-2966
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 HERRINGTON RD APT 19303
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-1817
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Country | US
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Telephone | 267-549-2966
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MR. STANLEY TROYD LEGRAND
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Credential | OTR/L
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Telephone | 267-549-2966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | OT004199
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License Number State | GA
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