Provider Demographics
NPI:1558978494
Name:GROSSMAN, VALARIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:VALARIE
Middle Name:
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6170 DEL RIO WAY
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2272
Mailing Address - Country:US
Mailing Address - Phone:415-676-9274
Mailing Address - Fax:
Practice Address - Street 1:6170 DEL RIO WAY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2272
Practice Address - Country:US
Practice Address - Phone:415-676-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist