Doctor Name: | KELLY GRACE |
NPI Number: | 1902196595 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | 602786-11 |
Business Practice Address: | 850 W Ironwood Dr 302 Coeur D Alene, ID - 838144903 |
Business Phone Number: | 2086645225 |
Business Fax Number: | 2086645228 |
Mailing Address: | 850 W Ironwood Dr, 302 COEUR D ALENE |
State: | ID |
Postal Code: | 838144903 |
Phone Number: | 2086645225 |
Fax Number: | 2086645228 |
NPI Enumeration Date: | 04/15/2011 |
NPI Last Update Date: | 04/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 602786-11 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |