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General NPI Number Information
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NPI Number | 1164728184
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Entity Type | Organization
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Legal Business Name | JEANNE T GRAHAM, DOM,PA
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 950 S TAMIAMI TRL SUITE 205
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City | SARASOTA
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State | FL
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Zip | 34236-7840
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Country | US
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Telephone | 941-350-4723
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Fax |
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Provider Business Mailing Address
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Address Line | 5623 RAVENWOOD DR
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City | SARASOTA
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State | FL
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Zip | 34243-5209
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Country | US
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Telephone | 941-350-4723
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Fax |
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | JEANNE T GRAHAM
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Credential | A.P., LAC
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Telephone | 941-350-4723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP 2644
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License Number State | FL
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