MEDICARE: MRS. CAROL GRANT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003023250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL GRANT PT

Provider Business Mailing Address
First Line	:	7510 12TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 PHINNEY AVE NORTH
Second Line	:	NORSE HOME
City	:	SEATTLE
State	:	WA
Zip	:	98103
Country	:	US
Telephone Number	:	206-781-7436
Fax Number	:	206-781-7414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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