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NPI Code Detail

MEDICARE: DANIEL GRANT GROENEWEG

MEDICARE: DANIEL GRANT GROENEWEG
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
1225700000XMassage Therapist128196AK

General Provider Information

NPI Number : 1346863560
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL GRANT GROENEWEG
Provider Business Mailing Address
First Line : 13135 OLD GLENN HWY STE 100
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7584
Country : US
Telephone Number : 907-696-9090
Fax Number : 907-696-9091
Provider Business Practice Location Address
First Line : 13135 OLD GLENN HWY STE 100
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-7584
Country : US
Telephone Number : 907-696-9090
Fax Number : 907-696-9091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2020
Last Update Date : 05/21/2020

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Directions to “ DANIEL GRANT GROENEWEG ” Practice Location

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