Provider Demographics
NPI:1710164983
Name:GROSSMAN, AMY ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:MAPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:108 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1331
Mailing Address - Country:US
Mailing Address - Phone:440-226-0704
Mailing Address - Fax:
Practice Address - Street 1:425 WATER ST
Practice Address - Street 2:SLENDER YOU SPA
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1236
Practice Address - Country:US
Practice Address - Phone:440-286-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.012057225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist