Provider Demographics
NPI:1013367796
Name:GRAVELINE, ELIZABETH CATALANO (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CATALANO
Last Name:GRAVELINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GREENWICH OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5151
Mailing Address - Country:US
Mailing Address - Phone:203-869-1145
Mailing Address - Fax:203-869-6998
Practice Address - Street 1:6 GREENWICH OFFICE PARK
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5151
Practice Address - Country:US
Practice Address - Phone:203-869-1145
Practice Address - Fax:203-869-6998
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist