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General NPI Number Information
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NPI Number | 1528396934
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Entity Type | Individual
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Provider Name | AMY GRADDY ST. JOHN D.C., LMT
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Gender | Female
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 4011 W PLANO PKWY STE 100
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City | PLANO
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State | TX
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Zip | 75093-5620
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Country | US
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Telephone | 214-801-0741
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Fax | 888-972-1621
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Provider Business Mailing Address
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Address Line | 4011 W PLANO PKWY STE 100
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City | PLANO
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State | TX
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Zip | 75093-5620
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Country | US
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Telephone | 214-801-0741
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Fax | 888-972-1621
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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 | MT028852
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11054
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License Number State | TX
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