Provider Demographics
NPI:1164727020
Name:GRACE THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:GRACE THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GROSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-682-9974
Mailing Address - Street 1:280 RICHBRIAR ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 RICHBRIAR ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1858
Practice Address - Country:US
Practice Address - Phone:901-682-9974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty