Provider Demographics
NPI:1558430454
Name:LEGASPI, GRACE GAN (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:GAN
Last Name:LEGASPI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY GRACE
Other - Middle Name:GAN
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11504 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-8483
Mailing Address - Country:US
Mailing Address - Phone:661-817-2480
Mailing Address - Fax:661-902-5192
Practice Address - Street 1:2390 E FLORIDA AVE STE 201
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4754
Practice Address - Country:US
Practice Address - Phone:351-765-1474
Practice Address - Fax:951-765-1476
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT278122251X0800X, 2251G0304X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT27812AMedicare ID - Type Unspecified
CAPT27812Medicare ID - Type UnspecifiedPT LICENSE