Healthcare Provider Details

I. General information

NPI: 1750910287
Provider Name (Legal Business Name): GRAJALES PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SEQUOIA WAY
SAN FRANCISCO CA
94127-1826
US

IV. Provider business mailing address

95 SEQUOIA WAY
SAN FRANCISCO CA
94127-1826
US

V. Phone/Fax

Practice location:
  • Phone: 415-385-3569
  • Fax:
Mailing address:
  • Phone: 415-385-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RANDY GRAJALES
Title or Position: OWNER
Credential: PT
Phone: 415-385-3569