Provider Demographics
NPI:1467335166
Name:EAST, GRACE WILLIAMS (PTA)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:WILLIAMS
Last Name:EAST
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4819 RIVERSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5581
Mailing Address - Country:US
Mailing Address - Phone:434-421-6179
Mailing Address - Fax:434-421-6179
Practice Address - Street 1:4819 RIVERSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5581
Practice Address - Country:US
Practice Address - Phone:434-421-6179
Practice Address - Fax:434-421-6179
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306606756225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty