Provider Demographics
NPI:1144270489
Name:GRABENSTETTER, PETE (PT)
Entity type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:GRABENSTETTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5962 LA PLACE CT
Mailing Address - Street 2:STE 170
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8807
Mailing Address - Country:US
Mailing Address - Phone:800-929-4776
Mailing Address - Fax:760-931-8370
Practice Address - Street 1:400 S FARRELL DR
Practice Address - Street 2:STE B202
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7964
Practice Address - Country:US
Practice Address - Phone:760-327-3416
Practice Address - Fax:760-327-0606
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 32507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ66869Medicare ID - Type Unspecified