Provider Demographics
NPI:1538808845
Name:ATHERTON, GRACE ANN
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 NE 93RD CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-3115
Mailing Address - Country:US
Mailing Address - Phone:425-563-8218
Mailing Address - Fax:
Practice Address - Street 1:5500 NE 82ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-9410
Practice Address - Country:US
Practice Address - Phone:425-563-8218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist