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General NPI Number Information
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NPI Number | 1265243398
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Entity Type | Organization
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Legal Business Name | GRADUS PHYSIOTHERAPY PT PLLC
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 80 FIFTH AVENUE ROOM #1004
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 201-461-9333
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Fax | 201-461-0851
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Provider Business Mailing Address
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Address Line | 158 LINWOOD PLZ SUITE 308
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City | FORT LEE
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State | NJ
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Zip | 07024
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Country | US
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Telephone | 201-461-9333
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Fax | 201-461-0851
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Authorized Official
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Title or Position | PHYSICAL THERAPIST & PRESIDENT
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Name | DAVID PARK
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Credential | DPT
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Telephone | 201-461-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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