Provider Demographics
NPI:1194857821
Name:GRAVES, MICHAEL (RN,BSN ,MT,NMP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:RN,BSN ,MT,NMP
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MTI,CPT
Mailing Address - Street 1:4141 SOUTHWEST FWY STE 510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7334
Mailing Address - Country:US
Mailing Address - Phone:713-528-2097
Mailing Address - Fax:713-960-1122
Practice Address - Street 1:4141 SOUTHWEST FWY STE 510
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7334
Practice Address - Country:US
Practice Address - Phone:713-528-2097
Practice Address - Fax:713-665-7702
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX743151864225400000X
TXMT002051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1468225-01Medicaid
TX74-3151864OtherTIN