Provider Demographics
NPI:1962981589
Name:LEVERMORE, GRANT CHARLES (DPT)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:CHARLES
Last Name:LEVERMORE
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 1:284 S GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2714
Mailing Address - Country:US
Mailing Address - Phone:585-746-5685
Mailing Address - Fax:
Practice Address - Street 1:2333 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9356
Practice Address - Country:US
Practice Address - Phone:585-786-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist