MEDICARE: CHRISTIE GRAVETT

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
1	235Z00000X	Speech-Language Pathologist	SA 8935	FL

General Provider Information

NPI Number	:	1336474931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE GRAVETT

Provider Business Mailing Address
First Line	:	340 W 23RD ST STE H
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4541
Country	:	US
Telephone Number	:	850-215-3911
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 W 23RD ST STE H
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4541
Country	:	US
Telephone Number	:	850-215-3911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	10/15/2009

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Directions to “ CHRISTIE GRAVETT ” Practice Location

Language	Start Address	Practice Location

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