Individual
MR. DANE MATTHEW GRAVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1880 COLUMBUS DR, BASSETT, VA 24055-5389
(276) 629-4279
Mailing address
1880 COLUMBUS DR, BASSETT, VA 24055-5389
(276) 629-4279
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306000674
VA
Other
Enumeration date
06/18/2013
Last updated
06/18/2013
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