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NPI Code Detail

MEDICARE: LISA RENEE GRANTHAM PT

MEDICARE: LISA RENEE GRANTHAM 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
1225100000XPhysical Therapist26369CA

General Provider Information

NPI Number : 1891649430
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA RENEE GRANTHAM PT
Provider Business Mailing Address
First Line : 333 S BEAUDRY AVE FL 17
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-5105
Country : US
Telephone Number : 213-241-6200
Fax Number :
Provider Business Practice Location Address
First Line : 333 S BEAUDRY AVE FL 17
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-5105
Country : US
Telephone Number : 213-241-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2026
Last Update Date : 02/23/2026

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