Provider Demographics
NPI:1598082372
Name:GRAJALES, RANDY M (PT)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:M
Last Name:GRAJALES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SEQUOIA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1826
Mailing Address - Country:US
Mailing Address - Phone:415-385-3569
Mailing Address - Fax:415-334-7647
Practice Address - Street 1:95 SEQUOIA WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1826
Practice Address - Country:US
Practice Address - Phone:415-385-3569
Practice Address - Fax:415-334-7647
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 21674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist