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General NPI Number Information
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NPI Number | 1770338840
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Entity Type | Individual
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Provider Name | KELLY GRUBAUGH LMT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 14300 CORNERSTONE VILLAGE DR STE 323
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City | HOUSTON
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State | TX
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Zip | 77014-1249
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Country | US
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Telephone | 832-515-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 5819 PEBBLE SPRINGS DR
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City | HOUSTON
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State | TX
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Zip | 77066-2310
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Country | US
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Telephone | 832-515-4835
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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 | MT130278
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License Number State | TX
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