Healthcare Provider Details

I. General information

NPI: 1104730324
Provider Name (Legal Business Name): BOBBY MARCELINO GREGORY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N CHERRY ST STE 100
SPOKANE VALLEY WA
99216-2852
US

IV. Provider business mailing address

12702 W 4TH AVE
AIRWAY HEIGHTS WA
99001-5086
US

V. Phone/Fax

Practice location:
  • Phone: 509-863-6174
  • Fax:
Mailing address:
  • Phone: 619-863-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: