Provider Demographics
NPI:1376834044
Name:GRACE, JOEL (MPT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:GRACE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17937 I 45 S STE 143
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8783
Mailing Address - Country:US
Mailing Address - Phone:936-237-0015
Mailing Address - Fax:713-660-0931
Practice Address - Street 1:6108 S RICE AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2983
Practice Address - Country:US
Practice Address - Phone:713-660-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1173833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist