Provider Demographics
NPI:1134615990
Name:CIAMARICONE, GRACE KUCERA (DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:KUCERA
Last Name:CIAMARICONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANN
Other - Last Name:KUCERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4608 CEDAR POINT DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4608 CEDAR POINT DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-5372
Practice Address - Country:US
Practice Address - Phone:321-543-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1302903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist