Provider Demographics
NPI:1437905007
Name:O'GRADY, JAMES (DPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:O'GRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:3582 KNOLLVIEW CT SE APT 406
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5923
Mailing Address - Country:US
Mailing Address - Phone:269-352-2954
Mailing Address - Fax:
Practice Address - Street 1:2708 MEYER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-2333
Practice Address - Country:US
Practice Address - Phone:616-797-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist