Provider Demographics
NPI: | 1194030155 |
---|---|
Name: | GRACE THERAPIES, LLC |
Entity type: | Organization |
Organization Name: | GRACE THERAPIES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGING MEMBER/OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | RHONDA |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | DRAWDY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, CCC-SLP |
Authorized Official - Phone: | 772-201-5942 |
Mailing Address - Street 1: | 7664 GERMANY CANAL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT PIERCE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34987-3300 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 772-577-6964 |
Mailing Address - Fax: | 772-461-9954 |
Practice Address - Street 1: | 7664 GERMANY CANAL RD |
Practice Address - Street 2: | |
Practice Address - City: | FORT PIERCE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34987-3300 |
Practice Address - Country: | US |
Practice Address - Phone: | 772-577-6964 |
Practice Address - Fax: | 772-461-9954 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-08-15 |
Last Update Date: | 2024-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 890505300 | Medicaid | |
FL | 889862600 | Medicaid | |
FL | 001500400 | Medicaid | |
FL | 890505300 | Medicaid | |
FL | 889847200 | Medicaid |