Provider Demographics
NPI:1215326053
Name:ABRUZZO, GRACE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:ABRUZZO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13743 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2424
Mailing Address - Country:US
Mailing Address - Phone:424-253-8509
Mailing Address - Fax:424-389-7115
Practice Address - Street 1:13743 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2424
Practice Address - Country:US
Practice Address - Phone:424-253-8509
Practice Address - Fax:424-389-7115
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist