Provider Demographics
NPI:1194808709
Name:GRANJE, ANN LOUIS MARIE (RPT)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUIS MARIE
Last Name:GRANJE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 NW 1ST CT
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3931
Mailing Address - Country:US
Mailing Address - Phone:561-271-6534
Mailing Address - Fax:
Practice Address - Street 1:4121 NW 1ST CT
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3931
Practice Address - Country:US
Practice Address - Phone:561-271-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7804225100000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881601800Medicaid
FLPT7804OtherSTATE LICENSE PHYS. THER.