Provider Demographics
NPI:1619603289
Name:GROSS, NORA DANIELLE (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:DANIELLE
Last Name:GROSS
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23535 HATTERAS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3023
Mailing Address - Country:US
Mailing Address - Phone:917-588-3170
Mailing Address - Fax:
Practice Address - Street 1:23535 HATTERAS ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3023
Practice Address - Country:US
Practice Address - Phone:917-588-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist