Provider Demographics
NPI:1285392712
Name:GRANT, BRENTON JOHN (MPT BHSC)
Entity type:Individual
Prefix:MR
First Name:BRENTON
Middle Name:JOHN
Last Name:GRANT
Suffix:
Gender:M
Credentials:MPT BHSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 N BUFFALO DR UNIT 2237
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4901
Mailing Address - Country:US
Mailing Address - Phone:702-374-9491
Mailing Address - Fax:
Practice Address - Street 1:1395 RAIDERS WAY STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4615
Practice Address - Country:US
Practice Address - Phone:725-241-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic