Provider Demographics
NPI:1164011730
Name:GRACE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:GRACE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:253-313-5102
Mailing Address - Street 1:7195 WAGNER WAY
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6906
Mailing Address - Country:US
Mailing Address - Phone:253-313-5102
Mailing Address - Fax:253-527-5353
Practice Address - Street 1:7195 WAGNER WAY
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6906
Practice Address - Country:US
Practice Address - Phone:253-313-5102
Practice Address - Fax:253-527-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty