Provider Demographics
NPI:1730150236
Name:FORRESTER, GRACEANN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:GRACEANN
Middle Name:
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WALL ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1991 MARCUS AVE STE M115
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-3000
Practice Address - Country:US
Practice Address - Phone:516-467-8730
Practice Address - Fax:929-455-9148
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0109591174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB7546Medicare PIN
NYDD5498Medicare PIN
NYP88535Medicare UPIN