Individual
MICHELLE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1229 W HUNTINGTON WAY, MUSTANG, OK 73064-2323
(702) 347-0641
Mailing address
1229 W HUNTINGTON WAY, MUSTANG, OK 73064-2323
(702) 347-0641
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B29020293
—
OK
Enumeration date
10/14/2020
Last updated
10/14/2020
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