Provider Demographics
NPI:1194037952
Name:GRAHAM, SARA BLYTHE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BLYTHE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25335 BUDDE RD APT 134
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2228
Mailing Address - Country:US
Mailing Address - Phone:281-622-5160
Mailing Address - Fax:
Practice Address - Street 1:25335 BUDDE RD APT 134
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2228
Practice Address - Country:US
Practice Address - Phone:281-622-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2072521225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant