MEDICARE: ADAM GRANNAN DPT

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	0514330A	IN

General Provider Information

NPI Number	:	1386371441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM GRANNAN DPT

Provider Business Mailing Address
First Line	:	8721 KIPLING DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7964
Country	:	US
Telephone Number	:	812-403-0649
Fax Number	:

Provider Business Practice Location Address
First Line	:	8721 KIPLING DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7964
Country	:	US
Telephone Number	:	812-403-0649
Fax Number	:

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

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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Directions to “ ADAM GRANNAN DPT” Practice Location

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