Individual
GINA GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
5501019829
MI
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501019829
STATE OF MICHIGAN
MI
Enumeration date
11/24/2020
Last updated
12/27/2022
Update your record
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