Healthcare Provider Details

I. General information

NPI: 1235919366
Provider Name (Legal Business Name): GRACEYFEET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 BURDETTE RD
BETHESDA MD
20817-2801
US

IV. Provider business mailing address

5709 CHEVY CHASE PKWY NW
WASHINGTON DC
20015-2521
US

V. Phone/Fax

Practice location:
  • Phone: 202-210-7074
  • Fax:
Mailing address:
  • Phone: 202-210-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GEORGE CHRISTOPHER GRACEY
Title or Position: OWNER/CEO
Credential: MPT, CPED
Phone: 202-210-7074