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General NPI Number Information
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NPI Number | 1992900120
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Entity Type | Individual
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Provider Name | ANGIE B GRAVELINE PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 4510 VIEWRIDGE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92123-1637
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Country | US
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Telephone | 858-694-4905
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Fax |
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Provider Business Mailing Address
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Address Line | 826 ORMOND CT
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City | SAN DIEGO
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State | CA
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Zip | 92109-7330
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Country | US
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Telephone | 858-488-3483
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 27441
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License Number State | CA
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