Provider Demographics
NPI:1417707712
Name:GRAVADOR, AUDREY MARIE DORIMAN (PT)
Entity type:Individual
Prefix:MS
First Name:AUDREY MARIE
Middle Name:DORIMAN
Last Name:GRAVADOR
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:14204 BAYSIDE AVE STE 8L
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2300
Mailing Address - Country:US
Mailing Address - Phone:718-445-6477
Mailing Address - Fax:718-445-6933
Practice Address - Street 1:142-04 BAYSIDE AVENUE, SUITE 8L
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-445-6477
Practice Address - Fax:718-445-6933
Is Sole Proprietor?:No
Enumeration Date:2024-03-27
Last Update Date:2025-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY04971601225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist