Healthcare Provider Details

I. General information

NPI: 1043841810
Provider Name (Legal Business Name): RICKI DONNELL GRAHAM PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HUGH WALLIS RD S
LAFAYETTE LA
70508-2511
US

IV. Provider business mailing address

640 E EUBANK ST
MABANK TX
75147-7760
US

V. Phone/Fax

Practice location:
  • Phone: 866-542-4768
  • Fax:
Mailing address:
  • Phone: 866-542-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1088854
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: