Individual
ELIZABETH ANN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1757 PORT ROAD, MACHIASPORT, ME 04665
(207) 255-0532
(715) 242-1066
Mailing address
1757 PORT ROAD, MACHIASPORT, ME 04665
(207) 255-0532
(715) 242-1066
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT348
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011099
ANTHEM BCBS
—
Enumeration date
06/15/2007
Last updated
07/08/2007
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