Provider Demographics
NPI:1275269458
Name:GRANLUND, KIANNA (PTA)
Entity Type:Individual
Prefix:
First Name:KIANNA
Middle Name:
Last Name:GRANLUND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W COUNTY LINE RD APT 19-201
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-6507
Mailing Address - Country:US
Mailing Address - Phone:989-330-3208
Mailing Address - Fax:
Practice Address - Street 1:5920 S ESTES ST STE 220
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-8619
Practice Address - Country:US
Practice Address - Phone:989-330-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA0014177225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant