Basic Information
| Provider Information | |||||||||
| NPI: | 1164011730 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRACE PHYSICAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7195 WAGNER WAY | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983356906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533135102 | ||||||||
| FaxNumber: | 2535275353 | ||||||||
| Practice Location | |||||||||
| Address1: | 7195 WAGNER WAY | ||||||||
| Address2: | |||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983356906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533135102 | ||||||||
| FaxNumber: | 2535275353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2021 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | LYNCH | ||||||||
| AuthorizedOfficialFirstName: | GRACE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2533135102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.