MEDICARE: DR. ALLISON GRANZELLA DPT

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	297327	CA

General Provider Information

NPI Number	:	1841836814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON GRANZELLA DPT

Provider Business Mailing Address
First Line	:	29645 RANCHO CALIFORNIA RD STE 234
Second Line	:
City	:	TEMECULA
State	:	CA
Zip	:	92591-5211
Country	:	US
Telephone Number	:	951-200-3620
Fax Number	:	951-200-5811

Provider Business Practice Location Address
First Line	:	24671 MONROE AVE STE 101
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-2527
Country	:	US
Telephone Number	:	951-677-4105
Fax Number	:	951-677-4106

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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