Provider Demographics
NPI:1043805716
Name:HARVEY, GRACE (PT, DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3201
Mailing Address - Country:US
Mailing Address - Phone:423-598-8647
Mailing Address - Fax:
Practice Address - Street 1:1690 ROSE MOSS CT SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3969
Practice Address - Country:US
Practice Address - Phone:301-275-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist