Provider Demographics
NPI:1093839110
Name:MCGRALE, LINDA LOUISE (LICENSED MASSAGE PRA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOUISE
Last Name:MCGRALE
Suffix:
Gender:F
Credentials:LICENSED MASSAGE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-746-8516
Mailing Address - Fax:208-743-8722
Practice Address - Street 1:2802 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-746-8516
Practice Address - Fax:208-743-8722
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010096225700000X
01778400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist