Organization
SOVEREIGN GRACE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SANJEE BENJAMIN GERALDE ANG PT (FOUNDER)
(319) 601-9768
Entity
Organization
Contact information
Practice address
1850 SUNNYSIDE AVE, BURLINGTON, IA 52601-4423
(319) 601-9768
Mailing address
1850 SUNNYSIDE AVE, BURLINGTON, IA 52601-4423
(319) 601-9768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
03690
IA
Other
Enumeration date
11/08/2014
Last updated
11/08/2014
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