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General NPI Number Information
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NPI Number | 1649835158
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Entity Type | Individual
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Provider Name | GRACIE REID HARDY LMT
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Gender | Female
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 2505 POCOSHOCK PL STE 203
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-6356
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Country | US
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Telephone | 804-562-3943
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Fax | 804-562-8136
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Provider Business Mailing Address
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Address Line | 2505 POCOSHOCK PL STE 203
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-6356
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Country | US
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Telephone | 804-562-3943
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Fax | 804-562-8136
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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 | 0019008819
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License Number State | VA
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