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General NPI Number Information
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NPI Number | 1669110110
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Entity Type | Individual
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Provider Name | JOSE JUAN GARCIA GRANADOS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 2250 SHIPYARD BLVD STE 14
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City | WILMINGTON
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State | NC
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Zip | 28403-8070
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Country | US
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Telephone | 910-518-9951
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Fax | 910-597-9520
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Provider Business Mailing Address
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Address Line | 2250 SHIPYARD BLVD STE 14
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City | WILMINGTON
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State | NC
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Zip | 28403-8070
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Country | US
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Telephone | 910-518-9951
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Fax | 910-597-9520
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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 | P21315
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License Number State | NC
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