MEDICARE: JOSHUA ANDREW GRANT LMT, NCTMB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1174553978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ANDREW GRANT LMT, NCTMB

Provider Business Mailing Address
First Line	:	2027 VILLAGE LN
Second Line	:	SUITE 202
City	:	SOLVANG
State	:	CA
Zip	:	93463-2283
Country	:	US
Telephone Number	:	805-688-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 VILLAGE LN
Second Line	:	SUITE 202
City	:	SOLVANG
State	:	CA
Zip	:	93463-2283
Country	:	US
Telephone Number	:	805-688-0789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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