Provider Demographics
NPI:1659269157
Name:GRANDERSON, ROSS KAELUND (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:KAELUND
Last Name:GRANDERSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 MOUNT ROYAL DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2544
Mailing Address - Country:US
Mailing Address - Phone:901-734-2656
Mailing Address - Fax:
Practice Address - Street 1:2712 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5910
Practice Address - Country:US
Practice Address - Phone:770-491-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0177482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic