MEDICARE: BENJAMIN GRANT

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	225700000X	Massage Therapist	92420	CA

General Provider Information

NPI Number	:	1861280562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN GRANT

Provider Business Mailing Address
First Line	:	2974 SHARON CT
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 30TH ST STE 209-11
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-3870
Country	:	US
Telephone Number	:	916-513-9549
Fax Number	:

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

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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Directions to “ BENJAMIN GRANT ” Practice Location

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