Provider Demographics
NPI:1598278657
Name:DE MOTT GRADY, HONORA CLARE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HONORA
Middle Name:CLARE
Last Name:DE MOTT GRADY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1302
Mailing Address - Country:US
Mailing Address - Phone:607-279-7942
Mailing Address - Fax:
Practice Address - Street 1:609 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1302
Practice Address - Country:US
Practice Address - Phone:607-535-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist