Provider Demographics
NPI:1750589099
Name:GRANATA, CAROLYN PATRICIA
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:PATRICIA
Last Name:GRANATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-8951
Mailing Address - Country:US
Mailing Address - Phone:401-353-4488
Mailing Address - Fax:
Practice Address - Street 1:31 PARADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1720
Practice Address - Country:US
Practice Address - Phone:401-351-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00684225100000X
MA6005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist