Provider Demographics
NPI:1871742437
Name:GRAZETTE, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GRAZETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851S RL THORNTON FREEWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-2962
Mailing Address - Country:US
Mailing Address - Phone:214-941-3666
Mailing Address - Fax:214-941-4009
Practice Address - Street 1:851S RL THORNTON FREEWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-2962
Practice Address - Country:US
Practice Address - Phone:214-941-3666
Practice Address - Fax:214-941-4009
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107969225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107969OtherCARLA GRAVENKEMPER, OTR