Individual
GINA GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9201
(262) 329-1000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 329-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12117-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100022907
—
WI
Enumeration date
01/20/2016
Last updated
02/03/2025
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