Organization
BHUMIYAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY A GREY (MASSAGE THERAPIST)
(928) 713-9631
Entity
Organization
Contact information
Practice address
634 SCHEMMER DR STE 301, PRESCOTT, AZ 86305-2368
(928) 713-9631
Mailing address
PO BOX 96, SKULL VALLEY, AZ 86338-0096
(928) 713-9631
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
MT-10655
AZ
Other
Enumeration date
01/23/2014
Last updated
01/23/2014
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