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NPI Code Detail

MEDICARE: GENEVIEVE ANNE GRANT PTA

MEDICARE:   GENEVIEVE ANNE GRANT  PTA
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
1225200000XPhysical Therapy Assistant00457IA

General Provider Information

NPI Number : 1740774884
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVIEVE ANNE GRANT PTA
Provider Business Mailing Address
First Line : 4825 CEDAR DR
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-4954
Country : US
Telephone Number : 515-480-6473
Fax Number :
Provider Business Practice Location Address
First Line : 4825 CEDAR DR
Second Line :
City : WEST DES MOINES
State : IA
Zip : 50266-4954
Country : US
Telephone Number : 515-480-6473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2018
Last Update Date : 06/21/2018

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Directions to “ GENEVIEVE ANNE GRANT PTA” Practice Location

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