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General NPI Number Information
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NPI Number | 1912104696
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Entity Type | Individual
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Provider Name | LOUIS ROBERT MCGRANAGHAN JR. PT
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-8847
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Country | US
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Telephone | 253-312-4402
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Fax |
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Provider Business Mailing Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-435-0360
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Fax | 253-435-0325
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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 | PT00010515
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License Number State | WA
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