Provider Demographics
NPI:1376782839
Name:GRANDINETTI, JUDITH ANN (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:ANN
Last Name:GRANDINETTI
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 CREEKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3408
Mailing Address - Country:US
Mailing Address - Phone:703-628-9507
Mailing Address - Fax:
Practice Address - Street 1:6007 CREEKSTONE LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-3408
Practice Address - Country:US
Practice Address - Phone:703-628-9507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist