Provider Demographics
NPI:1447763875
Name:GRAHEK, LAICEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LAICEE
Middle Name:
Last Name:GRAHEK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3502
Mailing Address - Country:US
Mailing Address - Phone:619-422-0404
Mailing Address - Fax:619-422-4153
Practice Address - Street 1:320 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3502
Practice Address - Country:US
Practice Address - Phone:619-422-0404
Practice Address - Fax:619-422-0404
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation