Healthcare Provider Details

I. General information

NPI: 1235288945
Provider Name (Legal Business Name): KARLA JO GRASSMAN-PROKSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY # MC5068
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

5800 LAKE MURRAY BLVD UNIT 84
LA MESA CA
91942-2514
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-5829
  • Fax:
Mailing address:
  • Phone: 619-589-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 16741
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 16741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: