Provider Demographics
NPI:1083958649
Name:GRABER, MARIE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:L
Last Name:GRABER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17704 MONTERO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2373
Mailing Address - Country:US
Mailing Address - Phone:858-674-4489
Mailing Address - Fax:
Practice Address - Street 1:18655 W BERNARDO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3002
Practice Address - Country:US
Practice Address - Phone:858-592-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist