Full Grace Physical Therapy, PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

017135-1 Issued in NY

Legal business name

FULL GRACE PHYSICAL THERAPY, PC

Practice address

2 Gramatan Avenue, Suite 206
Mt. Vernon, NY 10550-2002

Phone

(914) 664-1380

Fax

(914) 664-1383

NPI assigned

Mar 14, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Ethelvida M Ciccone, PTNPI 1710199914

Title

Pres./Owner

Phone

(347) 885-5367

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ethelvida Ciccone, PT

  • Physical Therapist
  • Katonah, NY
  • NPI 1710199914
  Medicare reassignment Authorized official
• Joseph Anthony Ciccone, D.C.

  • Chiropractor
  • Chappaqua, NY
  • NPI 1518947183
  NPD

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

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520985600000",
    "number": "1598268740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 GRAMATAN AVENUE, SUITE 206",
            "city": "MT. VERNON",
            "state": "NY",
            "postal_code": "105502002",
            "telephone_number": "914-664-1380",
            "fax_number": "914-664-1383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GRAMATAN AVENUE, SUITE 206",
            "city": "MT. VERNON",
            "state": "NY",
            "postal_code": "105502002",
            "telephone_number": "914-664-1380",
            "fax_number": "914-664-1383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL GRACE PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-14",
        "last_updated": "2018-03-14",
        "status": "A",
        "authorized_official_last_name": "CICCONE",
        "authorized_official_first_name": "ETHELVIDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRES./OWNER",
        "authorized_official_telephone_number": "347-885-5367",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "017135-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerri-Ann L Fraser-Aitkens, LPN
• Shannon Fraser
• Phalguni Freeman
• Luciana O. Freitas, LMSW
• Esti Freud
• Fulton Therapy Services PC
• Jennifer Fung
• Marlene Elena Furtick
• Nadeen Galicia
• Monique Gallimore

• Physical Therapist in Mt. Vernon, NY
• Providers in Mt. Vernon, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.