Provider Demographics
NPI:1730498593
Name:GRACIE, KARI ANN (MPT)
Entity Type:Individual
Prefix:
First Name:KARI ANN
Middle Name:
Last Name:GRACIE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KARI ANN
Other - Middle Name:
Other - Last Name:PEPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:136 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2324
Mailing Address - Country:US
Mailing Address - Phone:413-788-2171
Mailing Address - Fax:
Practice Address - Street 1:136 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-2324
Practice Address - Country:US
Practice Address - Phone:413-788-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15073225100000X
CT009174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist