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NPI Code Detail

MEDICARE: DR. CORLEY ELIZABETH GRAVES PT, DPT

MEDICARE: DR. CORLEY ELIZABETH GRAVES PT, DPT
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 TherapistPT015279GA

General Provider Information

NPI Number : 1265108864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORLEY ELIZABETH GRAVES PT, DPT
Provider Business Mailing Address
First Line : 502 S FREMONT AVE APT 1312
Second Line :
City : TAMPA
State : FL
Zip : 33606-4324
Country : US
Telephone Number : 404-509-6396
Fax Number :
Provider Business Practice Location Address
First Line : 13000 BRUCE B DOWNS BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33612-4745
Country : US
Telephone Number : 813-972-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2021
Last Update Date : 08/23/2021

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