Individual
CHARLES O GRAVATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-1508
(919) 350-1475
Mailing address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-1508
(919) 350-1475
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12846
NC
225100000X
Physical Therapist
5501012011
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3400069F
—
NC
Enumeration date
07/29/2006
Last updated
10/08/2013
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