Doctor Name: | GRADY GLYNN |
NPI Number: | 1093110413 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 9811 |
Business Practice Address: | 3050 Centre Pointe Dr Suite Number 200 Roseville, MN - 551131102 |
Business Phone Number: | 6516314242 |
Business Fax Number: | |
Mailing Address: | 14660 Lola Ave, WASECA |
State: | MN |
Postal Code: | 560939002 |
Phone Number: | 5074611819 |
Fax Number: | |
NPI Enumeration Date: | 10/28/2014 |
NPI Last Update Date: | 10/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 9811 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |