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NPI Code Detail

MEDICARE: NICOLE GRANA RBT

MEDICARE: NICOLE GRANA RBT
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1548045081
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GRANA RBT
Provider Business Mailing Address
First Line : 1355 GARDEN OF THE GODS RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-3431
Country : US
Telephone Number : 719-212-6535
Fax Number : 719-212-6539
Provider Business Practice Location Address
First Line : 1355 GARDEN OF THE GODS RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-3431
Country : US
Telephone Number : 719-212-6535
Fax Number : 719-212-6539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2023
Last Update Date : 08/30/2023

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Directions to “ NICOLE GRANA RBT” Practice Location

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