Provider Demographics
NPI:1780146027
Name:GRANT, BRIAN NEAL (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:NEAL
Last Name:GRANT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW 1ST ST
Mailing Address - Street 2:STE 114
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1259
Mailing Address - Country:US
Mailing Address - Phone:812-402-0444
Mailing Address - Fax:812-402-0449
Practice Address - Street 1:101 NW 1ST ST STE 114
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1259
Practice Address - Country:US
Practice Address - Phone:812-402-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011575A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty