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General NPI Number Information
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NPI Number | 1740657444
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Entity Type | Organization
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Legal Business Name | GRAHAM PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 1 LMU DR ATHLETIC DEPARTMENT
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City | LOS ANGELES
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State | CA
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Zip | 90045-2650
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Country | US
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Telephone | 310-995-1669
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Fax |
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Provider Business Mailing Address
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Address Line | 247 MARKET ST UNIT C
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City | VENICE
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State | CA
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Zip | 90291-5317
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Country | US
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Telephone | 310-490-6811
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CINDY GRAHAM
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Credential | PT
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Telephone | 310-490-6811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT23946
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT23979
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License Number State | CA
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