Individual
MRS. GINEVRA AMBER GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
200 TAYLORSVILLE MOUNTAIN RD, PITMAN, PA 17964-9104
(570) 644-0489
Mailing address
1130 WALNUT STREET, ASHLAND, PA 17921-1845
(570) 875-2983
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009850-L
PA
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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