| Doctor Name: | JASON GRAHAM |
| NPI Number: | 1336513167 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 1264458 |
| Business Practice Address: | 2720 Western Center Blvd Suite 312 Fort Worth, TX - 761314302 |
| Business Phone Number: | 8178470200 |
| Business Fax Number: | |
| Mailing Address: | 10304 Grayhawk Ln, FORT WORTH |
| State: | TX |
| Postal Code: | 762448543 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2015 |
| NPI Last Update Date: | 11/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1264458 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |