Most Relevant Information
Provider Data
| NPI Number: | 1003391145 |
| Provider Name: | GRANT MEDLOCK |
| Entity Type: | Individual |
| Taxonomy Code: | 251E00000X |
| Specialty: | Home Health |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/25/2018 |
| Last Updated: | 09/25/2018 |
Provider Practice Location
2498 LYNN LAKE CIR S
SAINT PETERSBURG
FL
337126117
Practice Location Phone/Fax
| Phone: | 9135539394 |
| Fax: |
Provider Mailing Location
2498 LYNN LAKE CIR S
SAINT PETERSBURG
FL
337126117
Provider Mailing Phone/Fax
| Phone: | 9135539394 |
| Fax: |