Provider Demographics
NPI:1730103227
Name:GRACE THERAPY SERVICES
Entity Type:Organization
Organization Name:GRACE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-886-6282
Mailing Address - Street 1:3620 KEITH BRIDGE RD
Mailing Address - Street 2:#220
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-886-6282
Mailing Address - Fax:
Practice Address - Street 1:3260 KEITH BRIDGE RD
Practice Address - Street 2:#220
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-3937
Practice Address - Country:US
Practice Address - Phone:770-886-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty