Provider Demographics
NPI:1902449655
Name:GRANUCCI, ALLISON M (DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:GRANUCCI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:ELIZABETH
Other - Last Name:MCFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2440 GOLD STAR HWY UNIT 201
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1180
Mailing Address - Country:US
Mailing Address - Phone:860-536-1001
Mailing Address - Fax:860-536-1527
Practice Address - Street 1:166 S RIVER RD STE 104
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6928
Practice Address - Country:US
Practice Address - Phone:603-782-3039
Practice Address - Fax:603-782-3667
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12338225100000X
NH5097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist