Provider Demographics
NPI:1225289879
Name:GRASSIE, MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:GRASSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 3353
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326-9616
Mailing Address - Country:US
Mailing Address - Phone:570-839-0620
Mailing Address - Fax:570-839-1260
Practice Address - Street 1:RR 3 BOX 3353
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:PA
Practice Address - Zip Code:18326-9616
Practice Address - Country:US
Practice Address - Phone:570-839-0620
Practice Address - Fax:570-839-1260
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist