MEDICARE: ANN ELIZABETH GRAB PT

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	225100000X	Physical Therapist	6029	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720286883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN ELIZABETH GRAB PT

Provider Business Mailing Address
First Line	:	1651 OLD MEADOW RD
Second Line	:	STE 600
City	:	MC LEAN
State	:	VA
Zip	:	22102-4311
Country	:	US
Telephone Number	:	703-506-0123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 N 44TH ST
Second Line	:	STE 101A
City	:	PHOENIX
State	:	AZ
Zip	:	85008-1583
Country	:	US
Telephone Number	:	480-990-9095
Fax Number	:	480-941-1233

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	02/01/2010

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