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NPI Code Detail

MEDICARE: MR. ANTHONY STUART GRAVIN DPT

MEDICARE: MR. ANTHONY STUART GRAVIN DPT
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
1225100000XPhysical Therapist070.021832IL

General Provider Information

NPI Number : 1649640988
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY STUART GRAVIN DPT
Provider Business Mailing Address
First Line : 1419 W GEORGE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-4103
Country : US
Telephone Number : 916-505-3101
Fax Number :
Provider Business Practice Location Address
First Line : 412 W 31ST ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3116
Country : US
Telephone Number : 312-225-3119
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2015
Last Update Date : 09/29/2015

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