Provider Demographics
NPI:1194845123
Name:GRADZIEL, LISA BETH (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
Last Name:GRADZIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:THE CENTER FOR DISCOVERY
Mailing Address - City:HARRIS
Mailing Address - State:NY
Mailing Address - Zip Code:12742
Mailing Address - Country:US
Mailing Address - Phone:845-794-1400
Mailing Address - Fax:845-707-8115
Practice Address - Street 1:139 BENMOSCHE ROAD
Practice Address - Street 2:THE CENTER FOR DISCOVERY
Practice Address - City:HARRIS
Practice Address - State:NY
Practice Address - Zip Code:12742
Practice Address - Country:US
Practice Address - Phone:845-794-1400
Practice Address - Fax:845-707-8115
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026701-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist