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Individual

KEVIN JOSEPH GRANGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T. A.

Contact information

Practice address
4308 CARLISLE BLVD, NE, SUITE 209, ALBUQUERQUE, NM 87107
(505) 828-0232
Mailing address
7 JUNIPER PL, LOS LUNAS, NM 87031-5781
(505) 261-5943

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-160
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A-160
PHYSICAL THERAPIST ASST
NM
Enumeration date
03/07/2007
Last updated
07/08/2007
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