Provider Demographics
NPI:1790937688
Name:GROVES, TAWNA L (LMP)
Entity Type:Individual
Prefix:
First Name:TAWNA
Middle Name:L
Last Name:GROVES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TAWNA
Other - Middle Name:L
Other - Last Name:PAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:7454 OLALLA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-9408
Mailing Address - Country:US
Mailing Address - Phone:509-670-5167
Mailing Address - Fax:
Practice Address - Street 1:321 9TH ST
Practice Address - Street 2:#201
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1464
Practice Address - Country:US
Practice Address - Phone:509-670-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist