Provider Demographics
NPI:1023180080
Name:GRACE LEGASPI CORPORATION
Entity Type:Organization
Organization Name:GRACE LEGASPI CORPORATION
Other - Org Name:GRACE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:GAN
Authorized Official - Last Name:LEGASPI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-454-5808
Mailing Address - Street 1:9353 BOLSA AVE # D15
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5951
Mailing Address - Country:US
Mailing Address - Phone:714-454-5808
Mailing Address - Fax:714-775-7590
Practice Address - Street 1:9361 BOLSA AVE STE 104
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5953
Practice Address - Country:US
Practice Address - Phone:714-454-5808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT278122251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18837Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER