Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 043140 | NY |
NPI | 1033689179 |
---|---|
Provider Name | Luis Gracia |
First Address | New York, NY 10007-2056 |
Second Address | New York, NY 10007-2056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2018 |
Last Update Date | 07/12/2021 |