Provider Demographics
NPI:1649541137
Name:MEISENHOLDER, GRANT WILLIAM (DPT)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:WILLIAM
Last Name:MEISENHOLDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 TULANE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-3222
Mailing Address - Country:US
Mailing Address - Phone:619-913-9236
Mailing Address - Fax:
Practice Address - Street 1:5818 TULANE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-3222
Practice Address - Country:US
Practice Address - Phone:619-913-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist