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General NPI Number Information
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NPI Number | 1134140304
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Entity Type | Individual
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Provider Name | MARK JOSEPH GRANGER PT
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 4223 ORANGE BEACH BLVD SUITE D
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City | ORANGE BEACH
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State | AL
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Zip | 36561-3459
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Country | US
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Telephone | 251-981-1300
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Fax | 251-981-1305
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Provider Business Mailing Address
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Address Line | 1908 FLINT RD SE
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City | DECATUR
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State | AL
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Zip | 35601-6031
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Country | US
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Telephone | 256-340-9708
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Fax | 256-340-9624
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH3635
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License Number State | AL
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