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NPI Code Detail

MEDICARE: MARIAN GRAFF PT

MEDICARE: MARIAN GRAFF PT
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
1225100000XPhysical Therapist
2225100000XPhysical Therapist070011589IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070-011589OTHERILPT STATE LICENSE #

General Provider Information

NPI Number : 1619034808
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAN GRAFF PT
Provider Business Mailing Address
First Line : 18215 HARLEM AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3609
Country : US
Telephone Number : 708-444-2563
Fax Number : 708-444-2769
Provider Business Practice Location Address
First Line : 18215 HARLEM AVE
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-3609
Country : US
Telephone Number : 708-444-2563
Fax Number : 708-444-2769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 10/03/2011

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