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General NPI Number Information
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NPI Number | 1124266739
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Entity Type | Individual
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Provider Name | HOLLY L GROSS LMP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 03/13/2015
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Provider Practice Location Address
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Address Line | 9500 ROOSEVELT WAY NE SUITE 210
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City | SEATTLE
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State | WA
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Zip | 98115-2252
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Country | US
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Telephone | 425-829-4348
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Fax |
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Provider Business Mailing Address
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Address Line | 5508 NE 180TH ST
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-4332
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Country | US
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Telephone | 425-829-4348
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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 | MA00025363
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License Number State | WA
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