Healthcare Provider Details

I. General information

NPI: 1952785669
Provider Name (Legal Business Name): JOSEPH P GRAVINO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 SWEET HOME RD STE 1-02
AMHERST NY
14228-2329
US

IV. Provider business mailing address

2360 SWEET HOME RD STE 1-02
AMHERST NY
14228-2329
US

V. Phone/Fax

Practice location:
  • Phone: 716-525-1184
  • Fax: 716-243-4721
Mailing address:
  • Phone: 716-525-1184
  • Fax: 716-243-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: