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General NPI Number Information
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NPI Number | 1639950363
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Entity Type | Individual
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Provider Name | GRACE INCLEDON PT
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Gender | Female
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 2031 PLANK RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-5103
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Country | US
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Telephone | 540-373-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 230 RIDGE RD
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City | HIGHLAND MILLS
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State | NY
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Zip | 10930-2103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305216123
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License Number State | VA
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