Healthcare Provider Details

I. General information

NPI: 1174432595
Provider Name (Legal Business Name): JENNA GRACE GRUNZKE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 S KNIK GOOSE BAY RD STE E
WASILLA AK
99654-8090
US

IV. Provider business mailing address

613 S KNIK GOOSE BAY RD STE E
WASILLA AK
99654-8090
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-5895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number257125
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: