Provider Demographics
NPI:1770504540
Name:FOLEY, GRANT WILLIAM (PTA)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:WILLIAM
Last Name:FOLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6234
Mailing Address - Country:US
Mailing Address - Phone:317-908-7307
Mailing Address - Fax:
Practice Address - Street 1:1570 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6234
Practice Address - Country:US
Practice Address - Phone:317-908-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002308A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant