Individual
ROBERT KELLY GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP, NCTMB
Contact information
Practice address
1836 WESTLAKE AVE N, SUITE 102, SEATTLE, WA 98109-2755
(206) 914-0288
Mailing address
1836 WESTLAKE AVE N, SUITE 102, SEATTLE, WA 98109-2755
(206) 914-0288
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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