Healthcare Provider Details

I. General information

NPI: 1841073277
Provider Name (Legal Business Name): JOHN M GRACIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22659 PACIFIC HWY S STE 201
DES MOINES WA
98198-5155
US

IV. Provider business mailing address

3445 S 176TH ST UNIT 314
SEATAC WA
98188-4047
US

V. Phone/Fax

Practice location:
  • Phone: 206-824-3668
  • Fax:
Mailing address:
  • Phone: 646-925-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: