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General NPI Number Information
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NPI Number | 1992673446
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Entity Type | Individual
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Provider Name | ALLISON JEAN GRACE BRANSON
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Gender | Female
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 116 E 3RD ST
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City | MOSCOW
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State | ID
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Zip | 83843-4318
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Country | US
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Telephone | 509-339-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 NW ROBERT ST
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City | PULLMAN
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State | WA
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Zip | 99163-3692
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Country | US
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Telephone | 509-339-3740
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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 | 4571678
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License Number State | ID
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