Provider Demographics
NPI:1538157052
Name:GRANT, JAMES M (MS, ATC, PES)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:GRANT
Suffix:
Gender:M
Credentials:MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3537
Mailing Address - Country:US
Mailing Address - Phone:585-385-3744
Mailing Address - Fax:585-385-5221
Practice Address - Street 1:3690 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3537
Practice Address - Country:US
Practice Address - Phone:585-385-3744
Practice Address - Fax:585-385-5221
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer