MEDICARE: EMILIE ELIZABETHANN GROVER

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		AK

General Provider Information

NPI Number	:	1063277705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIE ELIZABETHANN GROVER

Provider Business Mailing Address
First Line	:	16607 E HUNTLEY RD
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8718
Country	:	US
Telephone Number	:	907-982-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	16607 E HUNTLEY RD
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-8718
Country	:	US
Telephone Number	:	907-982-8639
Fax Number	:

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	02/20/2024

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Directions to “ EMILIE ELIZABETHANN GROVER ” Practice Location

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