MEDICARE: LOUISE GRANT

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	16351	FL

General Provider Information

NPI Number	:	1114816063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE GRANT

Provider Business Mailing Address
First Line	:	6417 BRANCHWOOD DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7380
Country	:	US
Telephone Number	:	561-632-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	6417 BRANCHWOOD DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7380
Country	:	US
Telephone Number	:	561-632-0208
Fax Number	:

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

Provider Enumeration Date	:	07/02/2025
Last Update Date	:	07/15/2025

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Directions to “ LOUISE GRANT ” Practice Location

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