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General NPI Number Information
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NPI Number | 1912814583
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Entity Type | Individual
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Provider Name | IAN GRAPE
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Gender | Male
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 3300 W COMMUNITY DR
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City | MUNCIE
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State | IN
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Zip | 47304-5457
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Country | US
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Telephone | 765-751-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 W COMMUNITY DR
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City | MUNCIE
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State | IN
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Zip | 47304-5457
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 05016268A
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License Number State | IN
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