Basic Information
| Provider Information | |||||||||
| NPI: | 1326376690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINKLE | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 TOWN CTR | ||||||||
| Address2: | SUITE 2001 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480751110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483520314 | ||||||||
| FaxNumber: | 2482810759 | ||||||||
| Practice Location | |||||||||
| Address1: | 877 FOREST HILL AVE SE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495462380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166101097 | ||||||||
| FaxNumber: | 6169404594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2009 | ||||||||
| LastUpdateDate: | 11/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.