Healthcare Provider Details

I. General information

NPI: 1760395602
Provider Name (Legal Business Name): DARA GRACE POST MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 PARADISE DR
TIBURON CA
94920-1022
US

IV. Provider business mailing address

4939 PARADISE DR
TIBURON CA
94920-1022
US

V. Phone/Fax

Practice location:
  • Phone: 415-302-7499
  • Fax:
Mailing address:
  • Phone: 415-302-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number16494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: