Active NPI
Kevin Joseph Granger, P.T. A.
- Physical Therapy Assistant
- Albuquerque, NM
National Provider Identifier
1023148863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A-160
- Practice address
- 4308 Carlisle Blvd, NE
Suite 209
Albuquerque, NM 87107 - Phone
- (505) 828-0232
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A-160 | NM | Primary |
Addresses
Primary practice location
4308 Carlisle Blvd, NE
Suite 209
Albuquerque, NM 87107
Mailing address
7 Juniper PL
Los Lunas, NM 87031-5781
Phone (505) 261-5943
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A-160 | Other | NM | PHYSICAL THERAPIST ASST |
Other names 1
- Mr. Kevin Joseph Granger
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-160 | NM | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Communication Mobility Independence | Past | Accepting new patients | |
| Advantage Home Care, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Corus Health
- Primary Care Nurse Practitioner
- Albuquerque, NM
- NPI 1205887452
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023148863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7 JUNIPER PL",
"city": "LOS LUNAS",
"state": "NM",
"postal_code": "870315781",
"telephone_number": "505-261-5943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4308 CARLISLE BLVD, NE",
"address_2": "SUITE 209",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87107",
"telephone_number": "505-828-0232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANGER",
"first_name": "KEVIN",
"middle_name": "JOSEPH",
"credential": "P.T. A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NM",
"license": "A-160",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPIST ASST",
"identifier": "A-160",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KEVIN",
"last_name": "GRANGER",
"middle_name": "JOSEPH",
"prefix": "MR.",
"credential": "P.T.A.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.