MEDICARE: MS. KRISTEN HELENE GRAZIER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01741500	NJ
2	225100000X	Physical Therapist	LPT-013472	AZ

General Provider Information

NPI Number	:	1255856597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTEN HELENE GRAZIER DPT

Provider Business Mailing Address
First Line	:	7036 N 14TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-5409
Country	:	US
Telephone Number	:	646-852-0192
Fax Number	:	602-249-4115

Provider Business Practice Location Address
First Line	:	7540 N 19TH AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-7967
Country	:	US
Telephone Number	:	602-249-9129
Fax Number	:	602-249-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	03/14/2021

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