| Organization Name: | JERRY'S PHYSICAL THERAPY CLINIC, INC. |
| NPI Number: | 1053342709 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERALD ANTHONY GRZECHOWIAK (PRESIDENT/PHYSICAL THERAPIST) |
| Mailing Address: | 1320 Tara Hills Dr Suite D Pinole |
| State: | CA US |
| Postal Code: | 945642532 |
| Phone Number: | 5107247600 |
| Fax Number: | 5107248080 |
| NPI Enumeration Date: | 07/05/2006 |
| NPI Last Update Date: | 02/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT6872 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |