Provider Demographics
NPI:1528559531
Name:WEBSTER, GRANT (ATC, OPA-C)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:ATC, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 WAKITA DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5568
Mailing Address - Country:US
Mailing Address - Phone:205-587-8963
Mailing Address - Fax:
Practice Address - Street 1:100 MCGUIRE LN
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-3614
Practice Address - Country:US
Practice Address - Phone:205-587-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20000315722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer