Individual
ANGELINA RENEE GRADILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15818 N 25TH ST UNIT 124, PHOENIX, AZ 85032-3598
(812) 614-7679
Mailing address
15818 N 25TH ST UNIT 124, PHOENIX, AZ 85032-3598
(812) 614-7679
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
Primary
MT-3077
AZ
225700000X
Massage Therapist
Primary
MT-3077
AZ
Other
Enumeration date
03/26/2026
Last updated
04/10/2026
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