# SOVEREIGN GRACE THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679979280
- **Authorized official:** MR. SANJEE BENJAMIN GERALDE ANG PT (FOUNDER)
- **Authorized official phone:** (319) 601-9768

## Contact information

- **Practice address:** 1850 SUNNYSIDE AVE, BURLINGTON, IA 52601-4423
- **Practice address phone:** (319) 601-9768
- **Mailing address:** 1850 SUNNYSIDE AVE, BURLINGTON, IA 52601-4423
- **Mailing address phone:** (319) 601-9768

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 03690 | IA | Yes |

## Other

- **Enumeration date:** 11/08/2014
- **Last updated:** 11/08/2014