Provider Demographics
NPI:1407320211
Name:GRANDISON, TERIUS
Entity Type:Individual
Prefix:
First Name:TERIUS
Middle Name:
Last Name:GRANDISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WINDIGROVE DR APT 1126
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-7600
Mailing Address - Country:US
Mailing Address - Phone:540-742-0856
Mailing Address - Fax:
Practice Address - Street 1:357 WINDIGROVE DR APT 1126
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-7600
Practice Address - Country:US
Practice Address - Phone:540-742-0856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer