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General NPI Number Information
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NPI Number | 1649083635
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Entity Type | Individual
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Provider Name | JAMES COLIN GRADY LMT
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Gender | Male
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 31 EAST DAVIS STREET
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City | SANTA
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State | ID
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Zip | 83866
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Country | US
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Telephone | 208-295-9500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | SANTA
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State | ID
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Zip | 83866-0204
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Country | US
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Telephone | 208-295-9500
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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 | MAS4960
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS-4960
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License Number State | ID
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