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Individual
LARRY MICHAEL GRAVANTE
Active
Individual
LARRY MICHAEL GRAVANTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
014297-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000918366003
HEALTHNOW NY
NY
01
—
5056028
AETNA
NY
Enumeration date
06/30/2006
Last updated
07/08/2007
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