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NPI Code Detail

MEDICARE: MR. KEVIN P GRAHAM PT

MEDICARE: MR. KEVIN P GRAHAM PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT00003966WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205977386
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN P GRAHAM PT
Provider Business Mailing Address
First Line : 10505 19TH AVE SE
Second Line : SUITE B
City : EVERETT
State : WA
Zip : 98208-4280
Country : US
Telephone Number : 408-570-0510
Fax Number : 408-945-4018
Provider Business Practice Location Address
First Line : 9514 4TH ST NE
Second Line : SUITE 101
City : LAKE STEVENS
State : WA
Zip : 98258-1937
Country : US
Telephone Number : 425-397-2327
Fax Number : 425-377-0283
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 03/13/2013

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Directions to “ MR. KEVIN P GRAHAM PT” Practice Location

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