Provider Demographics
NPI:1184796674
Name:GRASSEL, ANN J (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:J
Last Name:GRASSEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:J
Other - Last Name:GRASSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2817 CROW CANYON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1639
Mailing Address - Country:US
Mailing Address - Phone:925-284-3840
Mailing Address - Fax:925-284-3873
Practice Address - Street 1:2817 CROW CANYON RD
Practice Address - Street 2:STE 104
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1639
Practice Address - Country:US
Practice Address - Phone:925-838-9846
Practice Address - Fax:925-838-9846
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA142052OtherMEDICARE PTAN