Healthcare Provider Details

I. General information

NPI: 1770479214
Provider Name (Legal Business Name): MICHAEL ANDREW GROUSE CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2044 FILLMORE ST FL 2
SAN FRANCISCO CA
94115-2781
US

IV. Provider business mailing address

447 34TH AVE APT 5
SAN FRANCISCO CA
94121-1644
US

V. Phone/Fax

Practice location:
  • Phone: 415-888-8368
  • Fax:
Mailing address:
  • Phone: 415-990-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: