Provider Demographics
NPI:1962972877
Name:JOCHEM, GRANT (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:
Last Name:JOCHEM
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 ALVARADO RD STE 118
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5007
Mailing Address - Country:US
Mailing Address - Phone:619-287-4678
Mailing Address - Fax:619-287-0350
Practice Address - Street 1:6475 ALVARADO RD STE 118
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5007
Practice Address - Country:US
Practice Address - Phone:619-287-4678
Practice Address - Fax:619-287-0350
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist