Provider Demographics
NPI:1720294945
Name:GRIGSBY, BARBARA ROSE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ROSE
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 33RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3920
Mailing Address - Country:US
Mailing Address - Phone:360-459-1734
Mailing Address - Fax:
Practice Address - Street 1:7213 33RD AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3920
Practice Address - Country:US
Practice Address - Phone:360-459-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004819225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist