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Organization
FULL GRACE PHYSICAL THERAPY, PC
Active
Organization
FULL GRACE PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ETHELVIDA M CICCONE PT (PRES./OWNER)
(347) 885-5367
Entity
Organization
Contact information
Practice address
2 GRAMATAN AVENUE, SUITE 206, MT. VERNON, NY 10550-2002
(914) 664-1380
(914) 664-1383
Mailing address
2 GRAMATAN AVENUE, SUITE 206, MT. VERNON, NY 10550-2002
(914) 664-1380
(914) 664-1383
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
017135-1
NY
Other
Enumeration date
03/14/2018
Last updated
03/14/2018
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