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1174398606 NPI number — JEREMY BLAKE GRAHAM DPT

NPI Number: 1174398606
Health Care Provider/Practitioner: JEREMY BLAKE GRAHAM DPT

Information about “1174398606” NPI (JEREMY BLAKE GRAHAM DPT) exists in 1174398606 in HTML format HTML  |  1174398606 in plain Text format TXT  |  1174398606 in PDF (Portable Document Format) PDF  |  1174398606 in an XML format XML  formats.

NPI Number : 1174398606 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174398606",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRAHAM",
    "FirstName": "JEREMY",
    "MiddleName": "BLAKE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2001 BUTTERFIELD RD STE 1600",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DOWNERS GROVE",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60515-1211",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-370-8206",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1451 DR EDWARD HILLARD DR STE 130",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUSCALOOSA",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35401-7449",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "205-561-5899",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/15/2023",
    "LastUpdateDate": "04/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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