Provider Demographics
NPI:1942531827
Name:GRANZELLA, MARGARET ROSE-ANDRIA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:ROSE-ANDRIA
Last Name:GRANZELLA
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:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:CO
Mailing Address - Zip Code:81641-1207
Mailing Address - Country:US
Mailing Address - Phone:970-942-9709
Mailing Address - Fax:
Practice Address - Street 1:594 MAIN ST.
Practice Address - Street 2:STE. 25
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641
Practice Address - Country:US
Practice Address - Phone:970-942-9709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15321225700000X
CO0015124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist