Healthcare Provider Details

I. General information

NPI: 1316451776
Provider Name (Legal Business Name): GRAYSON JAMES GRZEGORCZYK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 240
OLYMPIA WA
98506-5117
US

IV. Provider business mailing address

4916 BEECH RD
HOPE MI
48628-9608
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-3850
  • Fax:
Mailing address:
  • Phone: 989-600-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number293863
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60797093
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: