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General NPI Number Information
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NPI Number | 1710772447
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Entity Type | Organization
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Legal Business Name | TARRA GRAY LMP
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 7411 W CLEARWATER AVE STE B
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City | KENNEWICK
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State | WA
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Zip | 99336-1683
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Country | US
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Telephone | 509-591-5874
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Fax |
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Provider Business Mailing Address
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Address Line | 59004 N THOMAS RD
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City | BENTON CITY
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State | WA
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Zip | 99320-7630
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Country | US
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Telephone | 509-591-5874
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Fax |
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Authorized Official
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Title or Position | LMP
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Name | TARRA GRAY
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Credential |
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Telephone | 509-591-5874
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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 |
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License Number State |
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