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NPI Code Detail

MEDICARE: DEBORAH V GRAHAM LCPO

MEDICARE: DEBORAH V GRAHAM LCPO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Z00000XOrthotist52TX
2224P00000XProsthetist52TX

General Provider Information

NPI Number : 1497012074
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH V GRAHAM LCPO
Provider Business Mailing Address
First Line : PO BOX 99283
Second Line :
City : FORT WORTH
State : TX
Zip : 76199-0283
Country : US
Telephone Number : 817-877-0294
Fax Number : 817-877-0304
Provider Business Practice Location Address
First Line : 1719 8TH AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1349
Country : US
Telephone Number : 682-885-6294
Fax Number : 682-885-1135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2012
Last Update Date : 04/19/2012

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Directions to “ DEBORAH V GRAHAM LCPO” Practice Location

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