Provider Demographics
NPI:1730077207
Name:GRANT, MICHEALA KEISHA (LMT)
Entity type:Individual
Prefix:
First Name:MICHEALA
Middle Name:KEISHA
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 RAINTREE LN STE 213
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8919
Mailing Address - Country:US
Mailing Address - Phone:757-676-1313
Mailing Address - Fax:
Practice Address - Street 1:8001 RAINTREE LN STE 213
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8919
Practice Address - Country:US
Practice Address - Phone:757-676-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist