Individual
CARRIE L GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
842 N WESTHILL BLVD, APPLETON, WI 54914-5788
(920) 810-3180
Mailing address
N3252 KOZUZEK RD, PESHTIGO, WI 54157-9610
(920) 810-3180
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
4340-046
WI
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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