Individual
MONIQUE CELESTE GRAVLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1133 S 300 E, SALEM, UT 84653-5649
(801) 960-5515
Mailing address
1133 S 300 E, SALEM, UT 84653-5649
(801) 960-5515
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5212737-2402
UT
Other
Enumeration date
08/02/2018
Last updated
08/02/2018
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