Provider Demographics
NPI:1699298844
Name:BACANI, GRACE MANZO (PT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MANZO
Last Name:BACANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MORAY LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4122
Mailing Address - Country:US
Mailing Address - Phone:407-646-7703
Mailing Address - Fax:407-646-7713
Practice Address - Street 1:249 MORAY LN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4122
Practice Address - Country:US
Practice Address - Phone:407-646-7703
Practice Address - Fax:407-646-7713
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT136612081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine