Healthcare Provider Details

I. General information

NPI: 1740201730
Provider Name (Legal Business Name): KATHLEEN J. GRACE RPT APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 UNIVERSITY CENTER LN STE # 200
SAN DIEGO CA
92122-1006
US

IV. Provider business mailing address

8929 UNIVERSITY CENTER LN STE # 200
SAN DIEGO CA
92122-1006
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-3545
  • Fax: 858-457-0976
Mailing address:
  • Phone: 858-457-3545
  • Fax: 858-457-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9486PT
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number473
License Number StateCA

VIII. Authorized Official

Name: KATE J GRACE
Title or Position: OWNER
Credential:
Phone: 858-457-3545