Provider Demographics
NPI:1629045547
Name:GRANSBERY, BEVERLEY (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLEY
Middle Name:
Last Name:GRANSBERY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1500
Mailing Address - Country:US
Mailing Address - Phone:406-723-4268
Mailing Address - Fax:406-723-4274
Practice Address - Street 1:200 S CLARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1500
Practice Address - Country:US
Practice Address - Phone:406-723-4268
Practice Address - Fax:406-723-4274
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1694PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400000Medicaid
MT61788OtherBLUE CROSS/BLUE SHIELD
MTP00015265OtherRAILROAD MEDICARE