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General NPI Number Information
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NPI Number | 1114256534
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Entity Type | Organization
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Legal Business Name | GRACE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/14/2009
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Last Update Date | 12/14/2009
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Provider Practice Location Address
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Address Line | 2201 CHARLES ST SUITE 105
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3378
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Country | US
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Telephone | 540-899-6863
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Fax | 540-899-6865
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Provider Business Mailing Address
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Address Line | 2201 CHARLES ST SUITE 105
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3378
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Country | US
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Telephone | 540-899-6863
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Fax | 540-899-6865
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. CARL FRANCIS BRUNO
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Credential | P. T.
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Telephone | 540-899-6863
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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 | 2305004860
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License Number State | VA
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