Provider Demographics
NPI:1174809362
Name:GRUBB, GRANT ROBERTSON (LMP)
Entity type:Individual
Prefix:MR
First Name:GRANT
Middle Name:ROBERTSON
Last Name:GRUBB
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 48TH DR SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-4246
Mailing Address - Country:US
Mailing Address - Phone:253-229-8066
Mailing Address - Fax:
Practice Address - Street 1:13411 48TH DR SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-4246
Practice Address - Country:US
Practice Address - Phone:253-229-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60231897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist