Provider Demographics
NPI:1508034844
Name:GROSKLAUS, AMALIA HILDEGARD (LMP)
Entity Type:Individual
Prefix:MS
First Name:AMALIA
Middle Name:HILDEGARD
Last Name:GROSKLAUS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 N 33RD ST
Mailing Address - Street 2:UNIT 22-C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2500
Mailing Address - Country:US
Mailing Address - Phone:253-297-7808
Mailing Address - Fax:253-752-6779
Practice Address - Street 1:5702 N 33RD ST
Practice Address - Street 2:UNIT 22-C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-2500
Practice Address - Country:US
Practice Address - Phone:253-297-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024688225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist