Provider Demographics
NPI:1194549543
Name:GRANBERG, DEBORAH (MSPT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GRANBERG
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14786 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8565
Mailing Address - Country:US
Mailing Address - Phone:720-323-9238
Mailing Address - Fax:
Practice Address - Street 1:17351 DRAKE ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-5205
Practice Address - Country:US
Practice Address - Phone:303-908-0500
Practice Address - Fax:720-465-9320
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist