Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Wiley Grantham IV

Individual provider Physical Therapy Assistant · NPI 1619583689

Mr. Wiley Grantham IV is a Physical Therapy Assistant in Lake City, Florida. Licensed in Florida. Registered with an NPI since 2020.

Licensed in
FL
In the registry since
2020
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Practice location Address checks out

560 SW McFarlane Ave
Lake City, FL 32025-5614
Phone: (386) 758-4777
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence 26541 (FL)

Record details

NPI number1619583689
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 16, 2020
Last updated in NPPESSeptember 16, 2020
Certification dateSeptember 10, 2020
Mailing address438 Se Lillian Loop Apt 103, Lake City, FL 32025-7248

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