Individual
KELLY GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
850 W IRONWOOD DR, 302, COEUR D ALENE, ID 83814-4903
(208) 664-5225
(208) 664-5228
Mailing address
850 W IRONWOOD DR, 302, COEUR D ALENE, ID 83814-4903
(208) 664-5225
(208) 664-5228
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
602786-11
ID
Other
Enumeration date
04/15/2011
Last updated
04/15/2011
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