MEDICARE: TOD T GRAPES B.S. EX. SCIENCE

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	226300000X	Kinesiotherapist	N/A	NY

General Provider Information

NPI Number	:	1851622625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOD T GRAPES B.S. EX. SCIENCE

Provider Business Mailing Address
First Line	:	169 MANHATTAN AVE
Second Line	:	#6H
City	:	NEW YORK
State	:	NY
Zip	:	10025-3248
Country	:	US
Telephone Number	:	212-932-9557
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 MANHATTAN AVE.
Second Line	:	#6H
City	:	NEW YORK CITY
State	:	NY
Zip	:	10025-3248
Country	:	US
Telephone Number	:	212-932-9557
Fax Number	:

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

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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