Active NPI
Stephanie Marie Gravelle
- Physical Therapist
- Escanaba, MI
National Provider Identifier
1801004478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501012388
- Practice address
- 2900 3Rd Avenue South
Escanaba, MI 49829 - Phone
- (906) 786-5810
- Fax
- (906) 786-5372
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501012388 | MI | Primary |
Addresses
Primary practice location
2900 3Rd Avenue South
Escanaba, MI 49829
Mailing address
219 No 13TH Street
Escanaba, MI 49829
Phone (906) 786-3103
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5501012388 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801004478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 NO 13TH STREET",
"city": "ESCANABA",
"state": "MI",
"postal_code": "49829",
"telephone_number": "906-786-3103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 3RD AVENUE SOUTH",
"city": "ESCANABA",
"state": "MI",
"postal_code": "49829",
"telephone_number": "906-786-5810",
"fax_number": "906-786-5372"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVELLE",
"first_name": "STEPHANIE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501012388",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escanaba, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.