Provider Demographics
NPI:1154874345
Name:MCGRANE, GARRETT (PT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:MCGRANE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SHULT DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3009
Mailing Address - Country:US
Mailing Address - Phone:409-741-8472
Mailing Address - Fax:409-741-2342
Practice Address - Street 1:6444 CENTRAL CITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2058
Practice Address - Country:US
Practice Address - Phone:409-741-8472
Practice Address - Fax:409-741-2342
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1276352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist