Individual
MS. CHRISTA GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
98 STATE ST, PROCTORVILLE, OH 45669-8163
(740) 886-9403
(740) 446-5153
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5890
(740) 446-5532
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
002249
WV
225100000X
Physical Therapist
Primary
10893
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217253
ANTHEM BCBS
—
01
—
1659397826
NPI
—
01
—
2540807
MOLINA MEDICAID
OH
05
—
3810000890
—
WV
01
—
P00223767
RR MEDICARE
—
Enumeration date
07/14/2006
Last updated
07/31/2007
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