Provider Demographics
NPI:1326376690
Name:HINKLE, GRACE B (MT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:B
Last Name:HINKLE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 TOWN CTR
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1110
Mailing Address - Country:US
Mailing Address - Phone:248-352-0314
Mailing Address - Fax:248-281-0759
Practice Address - Street 1:877 FOREST HILL AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2380
Practice Address - Country:US
Practice Address - Phone:616-610-1097
Practice Address - Fax:616-940-4594
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist