Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | TE012721 | PA |
NPI | 1003400292 |
---|---|
Provider Name | Jeffrey A Gracie |
First Address | Windber, PA 15963-6804 |
Second Address | Windber, PA 15963-6804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2021 |
Last Update Date | 27/02/2021 |