Provider Demographics
NPI:1194030155
Name:GRACE THERAPIES, LLC.
Entity Type:Organization
Organization Name:GRACE THERAPIES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DRAWDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:772-201-5942
Mailing Address - Street 1:4715 KIRBY LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981
Mailing Address - Country:US
Mailing Address - Phone:772-577-6964
Mailing Address - Fax:772-461-9954
Practice Address - Street 1:4715 KIRBY LOOP RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981
Practice Address - Country:US
Practice Address - Phone:772-577-6964
Practice Address - Fax:772-461-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001219000Medicaid
FL889862600Medicaid
FL001500400Medicaid
FL890505300Medicaid
FL889847200Medicaid