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NPI Code Detail

MEDICARE: RICHARD GRANT II PTA

MEDICARE: RICHARD GRANT II 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 AssistantPA4467ME

General Provider Information

NPI Number : 1811373103
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD GRANT II PTA
Provider Business Mailing Address
First Line : 895 PORTLAND RD
Second Line :
City : SACO
State : ME
Zip : 04072-9673
Country : US
Telephone Number : 207-439-5104
Fax Number :
Provider Business Practice Location Address
First Line : 895 PORTLAND RD
Second Line :
City : SACO
State : ME
Zip : 04072-9673
Country : US
Telephone Number : 207-439-5104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2015
Last Update Date : 08/10/2015

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Directions to “ RICHARD GRANT II PTA” Practice Location

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