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1407979404 NPI number — TAMARA NANCY GRAVANO PT, DPT, GCS, CEEAA

NPI Number: 1407979404
Health Care Provider/Practitioner: TAMARA NANCY GRAVANO PT, DPT, GCS, CEEAA

Information about “1407979404” NPI (TAMARA NANCY GRAVANO PT, DPT, GCS, CEEAA) exists in 1407979404 in HTML format HTML  |  1407979404 in plain Text format TXT  |  1407979404 in PDF (Portable Document Format) PDF  |  1407979404 in an XML format XML  formats.

NPI Number : 1407979404 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407979404",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRAVANO",
    "FirstName": "TAMARA",
    "MiddleName": "NANCY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PT, DPT, GCS, CEEAA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2847 5TH AVE",
    "SecondLineMailingAddress": "MARSHALL UNIVERSITY SCHOOL OF PHYSICAL THERAPY,",
    "MailingAddressCityName": "HUNTINGTON",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "25702-1435",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2847 5TH AVE",
    "SecondLinePracticeLocationAddress": "MARSHALL UNIVERSITY SCHOOL OF PHYSICAL THERAPY,",
    "PracticeLocationAddressCityName": "HUNTINGTON",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "25702-1435",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-696-5616",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/06/2007",
    "LastUpdateDate": "05/05/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "PT 20800",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2251G0304X",
          "TaxonomyName": "Geriatric Physical Therapist",
          "LicenseNumber": "07435R",
          "LicenseNumberStateCode": "LA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2251G0304X",
          "TaxonomyName": "Geriatric Physical Therapist",
          "LicenseNumber": "PT 002939",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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