Doctor Name: | KELLY GRAHAM |
NPI Number: | 1255584603 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | MA0023317 |
Business Practice Address: | 400 Lee Blvd Lehigh Acres, FL - 339366829 |
Business Phone Number: | 2393699986 |
Business Fax Number: | 2393680986 |
Mailing Address: | 400 Lee Blvd, LEHIGH ACRES |
State: | FL |
Postal Code: | 339364923 |
Phone Number: | 2393699986 |
Fax Number: | 2393039986 |
NPI Enumeration Date: | 10/29/2008 |
NPI Last Update Date: | 05/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA0023317 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |