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General NPI Number Information
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NPI Number | 1063124196
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Entity Type | Organization
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Legal Business Name | MASSAGE GROTTOSF LLC
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 4333 CALIFORNIA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-1376
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Country | US
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Telephone | 415-234-3236
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Fax |
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Provider Business Mailing Address
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Address Line | 544 CHURCH ST APT 307
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-2052
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Country | US
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Telephone | 808-937-4342
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Fax |
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Authorized Official
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Title or Position | OWNER; LICENSED MASSAGE THERAPIST
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Name | JUSTIN AVERY
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Credential | CMT
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Telephone | 808-937-4342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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