Provider Demographics
NPI:1205874864
Name:GRAMSE, HOLLY L (PT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:L
Last Name:GRAMSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:403 W STANLEY ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8631
Practice Address - Country:US
Practice Address - Phone:360-691-4835
Practice Address - Fax:360-691-2545
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0355GROtherREGENCE
WA911745305-98223-A020OtherTRICARE
WA2250GROtherREGENCE BLUE SHIELD
WA0210075OtherDEPT. OF LABOR &INDUSTRY
WA4030GROtherREGENCE BLUE SHIELD
WA0354GROtherREGENCE
WA1170GROtherREGENCE BLUE SHIELD
WA1519GROtherREGENCE BLUE SHIELD
WA0273744OtherDEPT OF L& I
WA1020GROtherREGENCE BLUE SHIELD
WA8750GROtherREGENCE BLUE SHIELD
WA0273755OtherDEPT OF L&I
WA7777276OtherAETNA
WA8351124Medicaid
WA8941702OtherL&I CRIME VICTIMS
WA8351124Medicaid
WA1020GROtherREGENCE BLUE SHIELD
WA8750GROtherREGENCE BLUE SHIELD