Individual
MR. JASON ERIC GRANDEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT OCS
Contact information
Practice address
5130 WILSON BLVD, SUITE B-1, ARLINGTON, VA 22205
(703) 527-9557
(703) 526-0438
Mailing address
142 INGLE PL, ALEXANDRIA, VA 22304
(703) 370-3703
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2305202947
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
291437
BCBS
VA
Enumeration date
05/07/2007
Last updated
07/08/2007
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