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General NPI Number Information
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NPI Number | 1053623900
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Entity Type | Individual
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Provider Name | KERILYN GRAHAM DPT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 9139 W THUNDERBIRD RD STE 225
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City | PEORIA
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State | AZ
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Zip | 85381-4913
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Country | US
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Telephone | 602-317-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 151 N SUNRISE AVE STE 902
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City | ROSEVILLE
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State | CA
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Zip | 95661-2929
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Country | US
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Telephone | 602-317-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 300941
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8931
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License Number State | AZ
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