Basic Information
| Provider Information | |||||||||
| NPI: | 1679773790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17325 BELL NORTH DR | ||||||||
| Address2: | SUITE 2-B | ||||||||
| City: | SCHERTZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781543368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885904002 | ||||||||
| FaxNumber: | 2105904585 | ||||||||
| Practice Location | |||||||||
| Address1: | 4532 WEST GATE BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787451485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128927337 | ||||||||
| FaxNumber: | 5128927339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1175711 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.