MR. Mark Leslie Grogan

NPI #1811292501 in Madison, Mississippi

Provider Information

NPI Number: 1811292501
Entity Type: Individual
Name: MR. Mark Leslie Grogan
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Enumeration Date: Jan 11, 2011
Last Updated: Jan 11, 2011

Practice Location

Address: 401 BAPTIST DR
Address 2: SUITE 306
City: Madison
State: Mississippi
ZIP Code: 39110-2009
Phone: (601) 607-7204

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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