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General NPI Number Information
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NPI Number | 1982369286
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Entity Type | Organization
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Legal Business Name | MYOGRASP BODYWORK
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 2423 CAMINO DEL RIO S STE 213
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City | SAN DIEGO
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State | CA
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Zip | 92108-3735
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Country | US
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Telephone | 208-627-7637
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Fax |
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Provider Business Mailing Address
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Address Line | 10153 HOOPER ST
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City | SAN DIEGO
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State | CA
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Zip | 92124-3511
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Country | US
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Telephone | 208-627-7637
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | RAMONA MICHAELA SHATRAW
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Credential |
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Telephone | 208-627-7637
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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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