Provider Demographics
NPI:1740201730
Name:KATHLEEN J. GRACE RPT APC
Entity Type:Organization
Organization Name:KATHLEEN J. GRACE RPT APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-457-3545
Mailing Address - Street 1:8929 UNIVERSITY CENTER LN
Mailing Address - Street 2:STE # 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1006
Mailing Address - Country:US
Mailing Address - Phone:858-457-3545
Mailing Address - Fax:858-457-0976
Practice Address - Street 1:8929 UNIVERSITY CENTER LN
Practice Address - Street 2:STE # 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1006
Practice Address - Country:US
Practice Address - Phone:858-457-3545
Practice Address - Fax:858-457-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9486PT225100000X
CA473363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15003Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER