Healthcare Provider Details

I. General information

NPI: 1093351645
Provider Name (Legal Business Name): LORI GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 ESTATE SMITH BAY
ST THOMAS VI
00802-1324
US

IV. Provider business mailing address

15531 UPPER CAROLINA
ST JOHN VI
00830-9518
US

V. Phone/Fax

Practice location:
  • Phone: 340-714-2348
  • Fax:
Mailing address:
  • Phone: 317-691-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: