MEDICARE: KATRINA A GRAY LMP

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	60532444	WA

General Provider Information

NPI Number	:	1518572015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA A GRAY LMP

Provider Business Mailing Address
First Line	:	2117 S 126TH ST
Second Line	:
City	:	BURIEN
State	:	WA
Zip	:	98168-2352
Country	:	US
Telephone Number	:	253-304-3755
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 S HORTON ST # 740
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98134-1952
Country	:	US
Telephone Number	:	253-304-3755
Fax Number	:

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

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	09/11/2020

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Directions to “ KATRINA A GRAY LMP” Practice Location

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