Provider Demographics
NPI:1386668739
Name:GRACE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:GRACE PHYSICAL THERAPY, INC.
Other - Org Name:LAGUNA ORTHOPEDIC REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-443-5442
Mailing Address - Street 1:PO BOX 7840
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7840
Mailing Address - Country:US
Mailing Address - Phone:949-443-5442
Mailing Address - Fax:949-443-5463
Practice Address - Street 1:31341 NIGUEL RD STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4118
Practice Address - Country:US
Practice Address - Phone:949-443-5442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty