Provider Demographics
NPI:1932716982
Name:GRACE, SAFIYAH S
Entity Type:Individual
Prefix:
First Name:SAFIYAH
Middle Name:S
Last Name:GRACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 FLEUR DR APT 104
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1735
Mailing Address - Country:US
Mailing Address - Phone:151-549-1868
Mailing Address - Fax:
Practice Address - Street 1:1251 KEOSAUQUA WAY
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1013
Practice Address - Country:US
Practice Address - Phone:515-491-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006475225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist