Provider Demographics
NPI:1043465149
Name:GRANITO, CIBELE MAZILIAUSKAS (PT)
Entity type:Individual
Prefix:MISS
First Name:CIBELE
Middle Name:MAZILIAUSKAS
Last Name:GRANITO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1080 E STERNBERG RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-8796
Mailing Address - Country:US
Mailing Address - Phone:231-799-2200
Mailing Address - Fax:231-799-2201
Practice Address - Street 1:1080 E STERNBERG RD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-8796
Practice Address - Country:US
Practice Address - Phone:231-799-2200
Practice Address - Fax:231-799-2201
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010136162251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics