Provider Demographics
NPI:1003017856
Name:GRANQUIST, MEGAN D (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:D
Last Name:GRANQUIST
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1703
Mailing Address - Country:US
Mailing Address - Phone:253-208-3195
Mailing Address - Fax:
Practice Address - Street 1:4407 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1703
Practice Address - Country:US
Practice Address - Phone:253-208-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer