Provider Demographics
NPI:1538442892
Name:GROM, CAROL E (LMT, NCTM)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:GROM
Suffix:
Gender:F
Credentials:LMT, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59717
Mailing Address - Country:US
Mailing Address - Phone:406-388-8080
Mailing Address - Fax:406-388-9263
Practice Address - Street 1:409 W. MAIN
Practice Address - Street 2:SUITE E
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714
Practice Address - Country:US
Practice Address - Phone:406-388-8080
Practice Address - Fax:406-388-9263
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist