Individual
DR. LARISA IVETA GRANTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4000
Mailing address
2202 RAYMOND DR APT A3, LAFAYETTE, IN 47909-8328
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05013118A
IN
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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