Provider Demographics
NPI:1134244098
Name:ROLLINS, GRADY LEE JR (LPTA)
Entity type:Individual
Prefix:MR
First Name:GRADY
Middle Name:LEE
Last Name:ROLLINS
Suffix:JR
Gender:M
Credentials:LPTA
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Mailing Address - Street 1:4141 COUNTY ROAD 66
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-6200
Mailing Address - Country:US
Mailing Address - Phone:256-239-6784
Mailing Address - Fax:256-354-1294
Practice Address - Street 1:83825 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-1270
Practice Address - Country:US
Practice Address - Phone:256-354-2131
Practice Address - Fax:256-354-1294
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPTA3474225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant