MEDICARE: MR. DUANE ROBERT GRAVES MPT

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
1	225100000X	Physical Therapist	5501005083	MI

General Provider Information

NPI Number	:	1538375472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUANE ROBERT GRAVES MPT

Provider Business Mailing Address
First Line	:	18440 LINCOLN RD
Second Line	:
City	:	NEW LOTHROP
State	:	MI
Zip	:	48460-9637
Country	:	US
Telephone Number	:	810-638-4259
Fax Number	:	810-638-4259

Provider Business Practice Location Address
First Line	:	2500 N ELMS RD
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-9426
Country	:	US
Telephone Number	:	810-342-5550
Fax Number	:	810-342-5589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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