Provider Demographics
NPI:1255095097
Name:MCGRANAHAN, JENNIFER LOUISE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:MCGRANAHAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 HYDE PARK PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5846
Mailing Address - Country:US
Mailing Address - Phone:352-363-4122
Mailing Address - Fax:
Practice Address - Street 1:2156 W NINE MILE RD STE D
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9464
Practice Address - Country:US
Practice Address - Phone:850-746-0440
Practice Address - Fax:850-746-0441
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37623208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty