Active NPI
Amy Gracik
- Physical Therapist
- Fort Ashby, WV
National Provider Identifier
1669897799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 003137
- Practice address
- 1 Diane Drive
Fort Ashby, WV 26719 - Phone
- (304) 298-3602
- NPI assigned
- Feb 26, 2014
- Last updated
- Feb 26, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 003137 | WV | Primary |
| Physical Therapist | 225100000X | PT 022743 | PA |
Addresses
Primary practice location
1 Diane Drive
Fort Ashby, WV 26719
Mailing address
607 Woodridge Dr
Glen Dale, WV 26038-1318
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 022743 | PA | MD | Physical Therapist |
| PT 003137 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393372800000",
"number": "1669897799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "607 WOODRIDGE DR",
"city": "GLEN DALE",
"state": "WV",
"postal_code": "260381318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 DIANE DRIVE",
"city": "FORT ASHBY",
"state": "WV",
"postal_code": "26719",
"telephone_number": "304-298-3602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRACIK",
"first_name": "AMY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-26",
"last_updated": "2014-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT 003137",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT 022743",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Ashby, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.