Provider Demographics
NPI:1275145492
Name:GRANGER, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18921 HEIDELBERG RD
Mailing Address - Street 2:
Mailing Address - City:SILVERHILL
Mailing Address - State:AL
Mailing Address - Zip Code:36576-3014
Mailing Address - Country:US
Mailing Address - Phone:251-767-6327
Mailing Address - Fax:
Practice Address - Street 1:17048 SCENIC HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1142
Practice Address - Country:US
Practice Address - Phone:251-517-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1086225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14634253OtherCAQH