Provider Demographics
NPI:1649550815
Name:GRAND OAKS MASSAGE INC
Entity type:Organization
Organization Name:GRAND OAKS MASSAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAGRASSE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:813-495-0550
Mailing Address - Street 1:26314 WESLEY CHAPEL BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7208
Mailing Address - Country:US
Mailing Address - Phone:813-527-6987
Mailing Address - Fax:
Practice Address - Street 1:26314 WESLEY CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7208
Practice Address - Country:US
Practice Address - Phone:813-527-6987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM27230225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty