Provider Demographics
NPI:1598494882
Name:SANDROCK, GRANT (CPRS)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:SANDROCK
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S CHESTNUT ST STE 302
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3029
Mailing Address - Country:US
Mailing Address - Phone:330-297-7842
Mailing Address - Fax:
Practice Address - Street 1:209 S CHESTNUT ST STE 302
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3029
Practice Address - Country:US
Practice Address - Phone:330-297-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002282175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist