Provider Demographics
NPI:1124299698
Name:HARDEMAN, GRADY JONATHAN (ATC, LAT, ATC)
Entity type:Individual
Prefix:
First Name:GRADY
Middle Name:JONATHAN
Last Name:HARDEMAN
Suffix:
Gender:M
Credentials:ATC, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 LOMAX CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9001
Mailing Address - Country:US
Mailing Address - Phone:704-786-4321
Mailing Address - Fax:
Practice Address - Street 1:2338 LOMAX CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-9001
Practice Address - Country:US
Practice Address - Phone:704-786-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer