MEDICARE: DANIELLE C GRIES LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	023403	OR

General Provider Information

NPI Number	:	1013413715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE C GRIES LMT

Provider Business Mailing Address
First Line	:	175 W B ST STE J
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-4594
Country	:	US
Telephone Number	:	541-636-3905
Fax Number	:	541-505-9023

Provider Business Practice Location Address
First Line	:	175 W B ST
Second Line	:	BUILDING J
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477
Country	:	US
Telephone Number	:	541-636-3905
Fax Number	:	541-505-9023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	01/14/2026

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