Healthcare Provider Details

I. General information

NPI: 1750160628
Provider Name (Legal Business Name): GRACEY FOOT AND ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
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 Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GEORGE CHRISTOPHER GRACEY
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: PT
Phone: 202-210-7074