Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 20800 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | 07435R | LA |
Y | 2251G0304X | Physical Therapist - Geriatrics | PT 002939 | WV |
NPI | 1407979404 |
---|---|
Provider Name | Dr. Tamara Nancy Gravano |
First Address | Huntington, WV 25702-1435 |
Second Address | Huntington, WV 25702-1435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 05/05/2014 |