Healthcare Provider Details

I. General information

NPI: 1992697635
Provider Name (Legal Business Name): ERIK GRANGOOD PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S STRAITS HWY
INDIAN RIVER MI
49749-9713
US

IV. Provider business mailing address

2230 E MITCHELL RD STE B
PETOSKEY MI
49770-6601
US

V. Phone/Fax

Practice location:
  • Phone: 231-238-2302
  • Fax: 231-238-2303
Mailing address:
  • Phone: 231-348-1011
  • Fax: 231-348-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: