Individual
GLENDOLIN GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
105 VAN BUREN ST, PASSAIC, NJ 07055
(201) 724-4870
Mailing address
105 VAN BUREN ST, PASSAIC, NJ 07055
(201) 724-4870
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT00952700
NJ
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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