Organization
JERRY'S PHYSICAL THERAPY CLINIC, INC.
Active
Other names
PINOLE PHYSICAL THERAPY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD ANTHONY GRZECHOWIAK R.P.T. (PRESIDENT/PHYSICAL THERAPIST)
(510) 724-7600
Entity
Organization
Contact information
Practice address
1320 TARA HILLS DR, SUITE D, PINOLE, CA 94564-2532
(510) 724-7600
(510) 724-8080
Mailing address
1320 TARA HILLS DR, SUITE D, PINOLE, CA 94564-2532
(510) 724-7600
(510) 724-8080
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT6872
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG5790
RAILROAD MEDICARE GRP.#
CA
01
—
ZZZ06174Z
MEDICARE GROUP PTAN
CA
01
—
ZZZ55467Z
BLUESHIELD PROVIDER#
CA
Enumeration date
07/05/2006
Last updated
02/13/2008
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