Provider Demographics
NPI:1770479214
Name:GROUSE, MICHAEL ANDREW (CMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:GROUSE
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 34TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1644
Mailing Address - Country:US
Mailing Address - Phone:415-990-5105
Mailing Address - Fax:
Practice Address - Street 1:2044 FILLMORE ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2781
Practice Address - Country:US
Practice Address - Phone:415-888-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist