Provider Demographics
NPI:1578320479
Name:HANTZIS, GRACE (LMT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HANTZIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 ELLIOT ST # 250
Mailing Address - Street 2:
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:383 ELLIOT ST # 250
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1126
Practice Address - Country:US
Practice Address - Phone:617-964-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist