Provider Demographics
NPI:1245204163
Name:GRAFF, KEVIN (MS ATC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GRAFF
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 W GWEN ST
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-4202
Mailing Address - Country:US
Mailing Address - Phone:602-237-8222
Mailing Address - Fax:602-764-4406
Practice Address - Street 1:3921 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-1801
Practice Address - Country:US
Practice Address - Phone:602-764-4096
Practice Address - Fax:602-764-4406
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist