Basic Information
| Provider Information | |||||||||
| NPI: | 1316451776 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GRZEGORCZYK | ||||||||
| FirstName: | GRAYSON | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4916 BEECH RD | ||||||||
| Address2: | |||||||||
| City: | HOPE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486289608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896008484 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 LILLY RD NE STE 240 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604133850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2017 | ||||||||
| LastUpdateDate: | 11/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 293863 | CA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | PT60797093 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.