Provider Demographics
NPI:1982430195
Name:GROCE, JAMIE (LMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GROCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:DOMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4294 WOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77306-5876
Mailing Address - Country:US
Mailing Address - Phone:936-207-7088
Mailing Address - Fax:
Practice Address - Street 1:4294 WOOD LOOP
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77306-5876
Practice Address - Country:US
Practice Address - Phone:936-207-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT131891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist