MEDICARE: MR. MICHAEL JAMES GRANZIN 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	0011723	CO

General Provider Information

NPI Number	:	1215921481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JAMES GRANZIN PT

Provider Business Mailing Address
First Line	:	PO BOX 40,000
Second Line	:
City	:	VAIL
State	:	CO
Zip	:	81658
Country	:	US
Telephone Number	:	970-569-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 BEARD CREEK RD
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-6426
Country	:	US
Telephone Number	:	970-569-7770
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	12/06/2021

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