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NPI Code Detail

MEDICARE: NAOMI GRAVDAL PT, DPT

MEDICARE: NAOMI GRAVDAL PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPHYP331AK

General Provider Information

NPI Number : 1174496616
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAOMI GRAVDAL PT, DPT
Provider Business Mailing Address
First Line : PO BOX 876728
Second Line :
City : WASILLA
State : AK
Zip : 99687-6728
Country : US
Telephone Number : 907-315-6088
Fax Number :
Provider Business Practice Location Address
First Line : 1225 W SPRUCE AVE
Second Line :
City : WASILLA
State : AK
Zip : 99654-5326
Country : US
Telephone Number : 907-352-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2025
Last Update Date : 09/29/2025

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