Healthcare Provider Details

I. General information

NPI: 1235698895
Provider Name (Legal Business Name): CHASE MACKENZIE GRABOYES-REED LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 CHARNELTON ST
EUGENE OR
97401-2689
US

IV. Provider business mailing address

20622 SE 269TH ST
COVINGTON WA
98042-6130
US

V. Phone/Fax

Practice location:
  • Phone: 541-653-8692
  • Fax:
Mailing address:
  • Phone: 541-844-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number24844
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60922727
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: