Provider Demographics
NPI:1447524129
Name:GRANDI, SHARON M (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:GRANDI
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 W LINCOLN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2489
Mailing Address - Country:US
Mailing Address - Phone:509-949-4490
Mailing Address - Fax:
Practice Address - Street 1:1901 W LINCOLN AVE STE C
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2489
Practice Address - Country:US
Practice Address - Phone:509-949-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00003035225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist