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Individual

GRACENIA JEROME

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
821 SW 3RD CT, DELRAY BEACH, FL 33444
(215) 575-5073
Mailing address
821 SW 3RD CT, DELRAY BEACH, FL 33444-4436
(321) 557-5507

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2110520
TX
225200000X
Physical Therapy Assistant
Primary
49065
CA
225200000X
Physical Therapy Assistant
PTA25566
FL

Other

Enumeration date
08/22/2018
Last updated
08/23/2018
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