Provider Demographics
NPI:1023350865
Name:GRANDY, DAMON JOHN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:JOHN
Last Name:GRANDY
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 1:7159 S 233RD AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8736
Mailing Address - Country:US
Mailing Address - Phone:417-298-2372
Mailing Address - Fax:
Practice Address - Street 1:3117 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7164
Practice Address - Country:US
Practice Address - Phone:928-442-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9200225100000X
MO2009024412225100000X
ALPTH6368225100000X
HI3588225100000X
IDPT-3025225100000X
WYPT-1455225100000X
NM4147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist