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Individual

MS. DIANE MARIE GRANT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPTA

Contact information

Practice address
255 CENTRAL AVE, CHELSEA, MA 02150-3508
(617) 660-2601
Mailing address
255 CENTRAL AVE, CHELSEA, MA 02150-3508
(617) 660-2601

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7683
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
119470352
MA
Enumeration date
09/18/2012
Last updated
09/18/2012
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