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General NPI Number Information
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NPI Number | 1255447488
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Entity Type | Individual
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Provider Name | KATHY D. GRANGER PTA
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2002 JOHNSON ST SUITE 100
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City | JENNINGS
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State | LA
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Zip | 70546-3646
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Country | US
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Telephone | 337-824-4547
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Fax | 337-824-4548
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Provider Business Mailing Address
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Address Line | 1327 DULLES DR
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City | LAFAYETTE
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State | LA
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Zip | 70506-3873
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Country | US
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Telephone | 337-824-4547
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Fax | 337-824-4548
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A6997
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License Number State | LA
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