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General NPI Number Information
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NPI Number | 1205183225
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Entity Type | Individual
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Provider Name | WILMAN ANTONIO GRANDEZ
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Gender | Male
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 4728 HAMPDEN LN
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City | BETHESDA
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State | MD
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Zip | 20814-2910
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Country | US
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Telephone | 240-481-8248
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Fax |
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Provider Business Mailing Address
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Address Line | 13145 DAIRYMAID DR APT 204
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City | GERMANTOWN
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State | MD
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Zip | 20874-2326
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Country | US
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Telephone | 240-481-8248
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Fax |
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | M03594
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License Number State | MD
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