Provider Demographics
NPI:1265243398
Name:GRADUS PHYSIOTHERAPY PT PLLC
Entity type:Organization
Organization Name:GRADUS PHYSIOTHERAPY PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-461-9333
Mailing Address - Street 1:158 LINWOOD PLZ
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-461-9333
Mailing Address - Fax:201-461-0851
Practice Address - Street 1:80 FIFTH AVENUE
Practice Address - Street 2:ROOM #1004
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:201-461-9333
Practice Address - Fax:201-461-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty