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General NPI Number Information
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NPI Number | 1265728943
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Entity Type | Individual
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Provider Name | LANELL MAE GRAHAM D.P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 130 W 4TH ST
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City | VALENTINE
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State | NE
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Zip | 69201-1830
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Country | US
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Telephone | 402-376-1140
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Fax | 402-376-1140
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Provider Business Mailing Address
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Address Line | 130 W 4TH ST
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City | VALENTINE
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State | NE
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Zip | 69201-1830
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Country | US
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Telephone | 402-376-1140
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Fax | 402-376-1140
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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 | 2861
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License Number State | NE
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