Individual
ROBERT KELLY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP, NCTMB
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA 00017889
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
387113-00
NCBTMB CERTIFICATION NUMBER
WA
01
—
MA 00017889
MASSAGE PRACTITIONER LICENSE
WA
Enumeration date
10/16/2012
Last updated
10/16/2012
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