Organization
JERRY'S PHYSICAL THERAPY CLINIC, INC.
Active
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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