Healthcare Provider Details

I. General information

NPI: 1952837205
Provider Name (Legal Business Name): SHARYL W GRAYSON MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 SORRENTO VALLEY BLVD
SAN DIEGO CA
92121-1429
US

IV. Provider business mailing address

3933 HATTON ST
SAN DIEGO CA
92111-3407
US

V. Phone/Fax

Practice location:
  • Phone: 858-246-9711
  • Fax: 858-246-9710
Mailing address:
  • Phone: 858-449-9520
  • Fax: 858-492-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: