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NPI Code Detail

MEDICARE: REBECCA LEE GRAHAM MPT

MEDICARE: REBECCA LEE GRAHAM 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
1225100000XPhysical TherapistPT-3422HI
2225100000XPhysical Therapist6285NV

General Provider Information

NPI Number : 1841500147
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA LEE GRAHAM MPT
Provider Business Mailing Address
First Line : 2001 BUTTERFIELD RD STE 1600
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1211
Country : US
Telephone Number : 866-370-8206
Fax Number :
Provider Business Practice Location Address
First Line : 4370 BLUE DIAMOND RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89139-7787
Country : US
Telephone Number : 702-443-9301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2010
Last Update Date : 11/19/2024

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