Provider Demographics
NPI:1194846840
Name:GRANADA, NEJAMA R (PT)
Entity Type:Individual
Prefix:MISS
First Name:NEJAMA
Middle Name:R
Last Name:GRANADA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6914 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1747
Mailing Address - Country:US
Mailing Address - Phone:410-284-5441
Mailing Address - Fax:410-284-5442
Practice Address - Street 1:1220A E JOPPA RD STE 234
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5817
Practice Address - Country:US
Practice Address - Phone:410-337-2470
Practice Address - Fax:410-337-2471
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist