Provider Demographics
NPI:1336340207
Name:GRANT, GINEVRA AMBER (PT)
Entity Type:Individual
Prefix:MRS
First Name:GINEVRA
Middle Name:AMBER
Last Name:GRANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:GINEVRA
Other - Middle Name:AMBER
Other - Last Name:OLSHEFSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1130 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17921-1845
Mailing Address - Country:US
Mailing Address - Phone:570-875-2983
Mailing Address - Fax:
Practice Address - Street 1:200 TAYLORSVILLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:PA
Practice Address - Zip Code:17964-9104
Practice Address - Country:US
Practice Address - Phone:570-644-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009850-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist