Individual
LAURA SMITH GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 CAPE MAY DR, WILMINGTON, OH 45177-2065
(937) 382-2995
Mailing address
3575 CORNSTALK RD, WAYNESVILLE, OH 45068-8511
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA007782
OH
Other
Enumeration date
01/09/2019
Last updated
02/12/2019
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