Provider Demographics
NPI:1154041317
Name:GRONDIN, KIM (LMT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:GRONDIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:GRONDIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:28 NORTH AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1830
Mailing Address - Country:US
Mailing Address - Phone:207-313-2762
Mailing Address - Fax:
Practice Address - Street 1:20 NORTH AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1830
Practice Address - Country:US
Practice Address - Phone:207-313-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty