Provider Demographics
NPI:1629429774
Name:GRACE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GRACE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:RUZZEDDU
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-914-0896
Mailing Address - Street 1:5826 FAYETTEVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8684
Mailing Address - Country:US
Mailing Address - Phone:919-914-0896
Mailing Address - Fax:919-914-0942
Practice Address - Street 1:5826 FAYETTEVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8684
Practice Address - Country:US
Practice Address - Phone:919-914-0896
Practice Address - Fax:919-914-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty