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General NPI Number Information
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NPI Number | 1053342709
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Entity Type | Organization
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Legal Business Name | JERRY'S PHYSICAL THERAPY CLINIC, INC.
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 1320 TARA HILLS DR SUITE D
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City | PINOLE
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State | CA
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Zip | 94564-2532
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Country | US
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Telephone | 510-724-7600
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Fax | 510-724-8080
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Provider Business Mailing Address
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Address Line | 1320 TARA HILLS DR SUITE D
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City | PINOLE
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State | CA
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Zip | 94564-2532
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Country | US
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Telephone | 510-724-7600
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Fax | 510-724-8080
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | MR. GERALD ANTHONY GRZECHOWIAK
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Credential | R.P.T.
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Telephone | 510-724-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT6872
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License Number State | CA
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