Provider Demographics
NPI:1912409046
Name:GRAND THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:GRAND THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:TROYD
Authorized Official - Last Name:LEGRAND
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:267-549-2966
Mailing Address - Street 1:1400 HERRINGTON RD APT 19303
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-1817
Mailing Address - Country:US
Mailing Address - Phone:267-549-2966
Mailing Address - Fax:
Practice Address - Street 1:1600 ATKINSON RD STE 111
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5747
Practice Address - Country:US
Practice Address - Phone:267-549-2966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
GAOT004199261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy