Healthcare Provider Details

I. General information

NPI: 1649088105
Provider Name (Legal Business Name): MANIKKA GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANIKKA GRAHAM RKT

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1654
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: