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General NPI Number Information
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NPI Number | 1871990580
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Entity Type | Individual
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Provider Name | ROSALYN GRAHAM LMT
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 16317 EDDINGER RD
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City | BOWIE
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State | MD
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Zip | 20716-6327
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Country | US
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Telephone | 240-505-4405
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Fax |
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Provider Business Mailing Address
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Address Line | 16317 EDDINGER ROAD
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City | BOWIE
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State | MD
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Zip | 20716
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Country | US
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Telephone | 240-505-4405
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M02777
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019004374
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT0507
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License Number State | DC
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