MEDICARE: JOEL GRACE MPT

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	1173833	TX

General Provider Information

NPI Number	:	1376834044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL GRACE MPT

Provider Business Mailing Address
First Line	:	17937 I 45 S STE 143
Second Line	:
City	:	SHENANDOAH
State	:	TX
Zip	:	77385-8783
Country	:	US
Telephone Number	:	936-237-0015
Fax Number	:	713-660-0931

Provider Business Practice Location Address
First Line	:	6108 S RICE AVE STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-2983
Country	:	US
Telephone Number	:	713-660-0663
Fax Number	:

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

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	07/18/2022

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