Healthcare Provider Details

I. General information

NPI: 1770791071
Provider Name (Legal Business Name): JEFFERY GRZECHOWIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 LINDEN DR
CONCORD CA
94520-4014
US

IV. Provider business mailing address

1152 LINDEN DR
CONCORD CA
94520-4014
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-8014
  • Fax:
Mailing address:
  • Phone: 510-724-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: