Provider Demographics
NPI:1154780971
Name:GRANT, ROBIN (MPT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750A SHADY LN
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9539
Mailing Address - Country:US
Mailing Address - Phone:410-970-2400
Mailing Address - Fax:410-774-4090
Practice Address - Street 1:3750A SHADY LN
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9539
Practice Address - Country:US
Practice Address - Phone:410-970-2400
Practice Address - Fax:410-774-4090
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist