Provider Demographics
NPI:1891035713
Name:GRANITO, DAVID (MS,ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:GRANITO
Suffix:
Gender:M
Credentials:MS,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PATRIOT PL
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1374
Mailing Address - Country:US
Mailing Address - Phone:508-384-9158
Mailing Address - Fax:
Practice Address - Street 1:1 PATRIOT PL
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-1374
Practice Address - Country:US
Practice Address - Phone:508-384-9158
Practice Address - Fax:508-543-7627
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer