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General NPI Number Information
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NPI Number | 1275269458
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Entity Type | Individual
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Provider Name | KIANNA GRANLUND PTA
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Gender | Female
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 5920 S ESTES ST STE 220
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City | LITTLETON
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State | CO
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Zip | 80123-8619
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Country | US
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Telephone | 989-330-3208
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Fax |
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Provider Business Mailing Address
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Address Line | 600 W COUNTY LINE RD APT 19-201
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-6507
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Country | US
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Telephone | 989-330-3208
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA0014177
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License Number State | CO
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