Provider Demographics
NPI:1437872934
Name:ROHRENBACH, GRACEY RUTH (MA 61254933)
Entity Type:Individual
Prefix:
First Name:GRACEY
Middle Name:RUTH
Last Name:ROHRENBACH
Suffix:
Gender:F
Credentials:MA 61254933
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2767
Mailing Address - Country:US
Mailing Address - Phone:509-608-8777
Mailing Address - Fax:
Practice Address - Street 1:201 W RIVERSIDE AVE #302, SPOKANE, WA 99201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201
Practice Address - Country:US
Practice Address - Phone:509-389-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61254933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty