Provider Demographics
NPI:1255530697
Name:GRANGER, ANTHONY BRIAN (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BRIAN
Last Name:GRANGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2514
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:7737 MEANY AVE STE B5
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5267
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-616-9199
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43822251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ449042Medicaid
AZZ102616Medicare PIN
AZ449042Medicaid
AZ119637Medicare PIN
AZ119636Medicare PIN