Healthcare Provider Details

I. General information

NPI: 1386983302
Provider Name (Legal Business Name): RIANE GRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2476 NW SOUTH MANOR AVE
STUART FL
34994-9158
US

IV. Provider business mailing address

2476 NW SOUTH MANOR AVE
STUART FL
34994-9158
US

V. Phone/Fax

Practice location:
  • Phone: 772-708-3224
  • Fax:
Mailing address:
  • Phone: 772-708-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI2470
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ7750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: