Provider Demographics
NPI:1326377722
Name:GRITTA, MARQUE (LMBT)
Entity Type:Individual
Prefix:
First Name:MARQUE
Middle Name:
Last Name:GRITTA
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-9654
Mailing Address - Country:US
Mailing Address - Phone:828-712-5000
Mailing Address - Fax:
Practice Address - Street 1:43 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-9654
Practice Address - Country:US
Practice Address - Phone:828-712-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist