Provider Demographics
NPI:1518516632
Name:GRADY, JASON TYLER (DPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:TYLER
Last Name:GRADY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MARKET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6913
Mailing Address - Country:US
Mailing Address - Phone:901-861-9970
Mailing Address - Fax:
Practice Address - Street 1:85 MARKET CENTER DR
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-6913
Practice Address - Country:US
Practice Address - Phone:901-861-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist