Provider Demographics
NPI:1447793351
Name:GLEMBOCKI GARDNER, GRACE MARIE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:GLEMBOCKI GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MARIE
Other - Last Name:GLEMBOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 N RHODES ST
Mailing Address - Street 2:APT 208
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2920
Mailing Address - Country:US
Mailing Address - Phone:919-610-9469
Mailing Address - Fax:
Practice Address - Street 1:1512 N RHODES ST
Practice Address - Street 2:APT 208
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2920
Practice Address - Country:US
Practice Address - Phone:919-610-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist