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NPI Code Detail

MEDICARE: MS. JENNIFER R GRACEN M.S.P.T.

MEDICARE: MS. JENNIFER R GRACEN M.S.P.T.
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1578511838
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER R GRACEN M.S.P.T.
Provider Business Mailing Address
First Line : 1536 APACHE DR UNIT C
Second Line :
City : CHULA VISTA
State : CA
Zip : 91910-7148
Country : US
Telephone Number : 619-656-0155
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E PALOMAR ST
Second Line :
City : CHULA VISTA
State : CA
Zip : 91913-1800
Country : US
Telephone Number : 619-397-3077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 07/08/2007

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