Provider Demographics
NPI:1215577754
Name:GRANGER, STERLING (PTA)
Entity Type:Individual
Prefix:
First Name:STERLING
Middle Name:
Last Name:GRANGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PARKCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY ISLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72631-9230
Mailing Address - Country:US
Mailing Address - Phone:479-363-6422
Mailing Address - Fax:479-363-6763
Practice Address - Street 1:23 PARKCLIFF DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY ISLAND
Practice Address - State:AR
Practice Address - Zip Code:72631-9230
Practice Address - Country:US
Practice Address - Phone:479-363-6422
Practice Address - Fax:479-363-6763
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4376225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPTA4376OtherARKANSAS STATE BOARD OF PHYSICAL THERAPY