Healthcare Provider Details

I. General information

NPI: 1174553978
Provider Name (Legal Business Name): JOSHUA ANDREW GRANT LMT, NCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 VILLAGE LN SUITE 202
SOLVANG CA
93463-2283
US

IV. Provider business mailing address

2027 VILLAGE LN SUITE 202
SOLVANG CA
93463-2283
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-0789
  • Fax:
Mailing address:
  • Phone: 805-688-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: