Provider Demographics
NPI:1073695979
Name:PEDIATRIC THERAPY SERVICES OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SERVICES OF ORANGE COUNTY, INC.
Other - Org Name:SHARON GRADY PT, MS, PCS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, PCS
Authorized Official - Phone:714-427-0615
Mailing Address - Street 1:1525 MESA VERDE DR E
Mailing Address - Street 2:SUITE #120
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5218
Mailing Address - Country:US
Mailing Address - Phone:714-427-0615
Mailing Address - Fax:714-427-0617
Practice Address - Street 1:1525 MESA VERDE DR E
Practice Address - Street 2:SUITE #120
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5218
Practice Address - Country:US
Practice Address - Phone:714-427-0615
Practice Address - Fax:714-427-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty