Provider Demographics
NPI:1881072411
Name:GRACE THERAPIES
Entity type:Organization
Organization Name:GRACE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST ASST
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SORICELLI
Authorized Official - Suffix:
Authorized Official - Credentials:SLPA
Authorized Official - Phone:772-812-0491
Mailing Address - Street 1:10470 SW WATERWAY LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2494
Mailing Address - Country:US
Mailing Address - Phone:772-812-0491
Mailing Address - Fax:
Practice Address - Street 1:4715 KIRBY LOOP RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-5345
Practice Address - Country:US
Practice Address - Phone:772-461-9954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 25292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty