Provider Demographics
NPI:1457664633
Name:GRANOFF, ABBY REBECCA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ABBY
Middle Name:REBECCA
Last Name:GRANOFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 CROSSPOINTE LN STE 6
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2986
Mailing Address - Country:US
Mailing Address - Phone:585-347-4990
Mailing Address - Fax:585-347-4993
Practice Address - Street 1:1130 CROSSPOINTE LN STE 6
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2986
Practice Address - Country:US
Practice Address - Phone:585-347-4990
Practice Address - Fax:585-347-4993
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032819OtherLICENSE