Provider Demographics
NPI:1659397826
Name:GRADY, CHRISTA (PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:
Last Name:GRADY
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5890
Mailing Address - Fax:740-446-5532
Practice Address - Street 1:98 STATE ST
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8163
Practice Address - Country:US
Practice Address - Phone:740-886-9403
Practice Address - Fax:740-446-5153
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10893225100000X
WV002249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000890Medicaid
000000217253OtherANTHEM BCBS
P00223767OtherRR MEDICARE
OH2540807OtherMOLINA MEDICAID
1659397826OtherNPI
OH4148551Medicare PIN