Provider Demographics
NPI:1396727343
Name:GRALY, JANE MARCUS (PT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARCUS
Last Name:GRALY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ALICE
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3031 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 144
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2052
Mailing Address - Country:US
Mailing Address - Phone:510-841-6020
Mailing Address - Fax:541-841-6733
Practice Address - Street 1:3031 TELEGRAPH AVE
Practice Address - Street 2:SUITE 144
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2052
Practice Address - Country:US
Practice Address - Phone:510-841-6020
Practice Address - Fax:541-841-6733
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT197930Medicare PIN