Provider Demographics
NPI:1316451776
Name:GRZEGORCZYK, GRAYSON JAMES (DPT)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:JAMES
Last Name:GRZEGORCZYK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 BEECH RD
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:MI
Mailing Address - Zip Code:48628-9608
Mailing Address - Country:US
Mailing Address - Phone:989-600-8484
Mailing Address - Fax:
Practice Address - Street 1:615 LILLY RD NE STE 240
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5117
Practice Address - Country:US
Practice Address - Phone:360-413-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2938632251X0800X
WAPT60797093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic