Provider Demographics
NPI:1215192802
Name:GRANT, TRACEY M (DPT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:8002 KEW GARDENS RD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3600
Mailing Address - Country:US
Mailing Address - Phone:718-263-7500
Mailing Address - Fax:718-263-7502
Practice Address - Street 1:333 EARLE OVINGTON BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3610
Practice Address - Country:US
Practice Address - Phone:516-321-2400
Practice Address - Fax:516-321-2401
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY030409-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03248Medicare PIN