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General NPI Number Information
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NPI Number | 1124258751
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Entity Type | Individual
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Provider Name | RICHARD DAREN MCGRAW MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 621 PACIFIC AVE
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City | TACOMA
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State | WA
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Zip | 98402
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Country | US
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Telephone | 253-230-6873
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Fax | 253-879-8200
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Provider Business Mailing Address
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Address Line | 5019 N WHITMAN ST
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City | TACOMA
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State | WA
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Zip | 98407-1336
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Country | US
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Telephone | 253-230-6875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA00015811
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License Number State | WA
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