Provider Demographics
NPI:1689924789
Name:GRADY, ROBERT LEO
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEO
Last Name:GRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6544 GUMWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4415
Mailing Address - Country:US
Mailing Address - Phone:702-556-3304
Mailing Address - Fax:
Practice Address - Street 1:6544 GUMWOOD RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4415
Practice Address - Country:US
Practice Address - Phone:702-556-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner