Individual provider Active NPI

Stephanie L Gradone, DPT

  • Physical Therapist
  • Portland, ME
National Provider Identifier
1578660478
Registry record updated Nov 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4340 Issued in ME
Practice address
33 Sewall St
Portland, ME 04102-2603
Phone
(207) 828-2100
NPI assigned
Sep 20, 2006
Last updated
Nov 9, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT4340 ME Primary

Addresses

Primary practice location

33 Sewall St
Portland, ME 04102-2603

Mailing address

324 Gannett Dr Ste 200
South Portland, ME 04106-3266
Phone (207) 482-7800

Other names 1

  • Stephanie L Gray Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT4340MEMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Back on Track, P.C. Physical Therapist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1578660478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 GANNETT DR STE 200",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041063266",
            "telephone_number": "207-482-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 SEWALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022603",
            "telephone_number": "207-828-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADONE",
        "first_name": "STEPHANIE",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT4340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "GRAY",
            "middle_name": "L",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Portland, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.