Individual
DONNETA C GRIZZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
245 E PINE ST, CENTRAL POINT, OR 97502-2251
(541) 621-4966
Mailing address
543 PALO VERDE WAY, CENTRAL POINT, OR 97502-1761
(541) 621-4966
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18453
LICENSED MASSAGE THERAPIST
OR
Enumeration date
03/19/2013
Last updated
03/19/2013
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