Jerry'S Physical Therapy Clinic, Inc.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT6872 Issued in CA

Legal business name

JERRY'S PHYSICAL THERAPY CLINIC, INC.

Practice address

1320 Tara Hills Dr
Suite D
Pinole, CA 94564-2532

Phone

(510) 724-7600

Fax

(510) 724-8080

NPI assigned

Jul 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gerald Anthony Grzechowiak, R.P.T.

Title

President/Physical Therapist

Phone

(510) 724-7600

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• PINOLE PHYSICAL THERAPY CLINIC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1053342709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 TARA HILLS DR",
            "address_2": "SUITE D",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642532",
            "telephone_number": "510-724-7600",
            "fax_number": "510-724-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 TARA HILLS DR",
            "address_2": "SUITE D",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642532",
            "telephone_number": "510-724-7600",
            "fax_number": "510-724-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY'S PHYSICAL THERAPY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "GRZECHOWIAK",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "510-724-7600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "PT6872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GRP.#",
            "identifier": "DG5790",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "ZZZ06174Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUESHIELD PROVIDER#",
            "identifier": "ZZZ55467Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PINOLE PHYSICAL THERAPY CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapy Clinic/Center in Pinole, CA
• Providers in Pinole, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.