Provider Demographics
NPI:1063024412
Name:GRABER, RAYMOND (LMT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:GRABER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 ASPEN ST SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5768
Mailing Address - Country:US
Mailing Address - Phone:253-343-3959
Mailing Address - Fax:
Practice Address - Street 1:19041 FRONT ST NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7354
Practice Address - Country:US
Practice Address - Phone:360-271-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60631960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist