Provider Demographics
NPI:1487907986
Name:GRACE NEURO REHAB & WELLNESS, PC
Entity type:Organization
Organization Name:GRACE NEURO REHAB & WELLNESS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:STRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT, NCS, ATP
Authorized Official - Phone:520-429-9475
Mailing Address - Street 1:7628 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4201
Mailing Address - Country:US
Mailing Address - Phone:520-297-4723
Mailing Address - Fax:520-297-4726
Practice Address - Street 1:7628 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4201
Practice Address - Country:US
Practice Address - Phone:520-297-4723
Practice Address - Fax:520-297-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67942251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1952677213OtherINDIVIDUALMEDICARE NPI