Provider Demographics
NPI:1851622625
Name:GRAPES, TOD T (BS EX SCIENCE)
Entity Type:Individual
Prefix:
First Name:TOD
Middle Name:T
Last Name:GRAPES
Suffix:
Gender:M
Credentials:BS EX SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MANHATTAN AVE
Mailing Address - Street 2:#6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3248
Mailing Address - Country:US
Mailing Address - Phone:212-932-9557
Mailing Address - Fax:
Practice Address - Street 1:169 MANHATTAN AVE.
Practice Address - Street 2:#6H
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10025-3248
Practice Address - Country:US
Practice Address - Phone:212-932-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN/A226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist