Provider Demographics
NPI:1285032409
Name:GRAPHENTEEN, VASHTI ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:VASHTI
Middle Name:ROSE
Last Name:GRAPHENTEEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:VASHTI
Other - Middle Name:ROSE
Other - Last Name:DEROSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1460 CURVE CREST BLVD W
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6070
Mailing Address - Country:US
Mailing Address - Phone:651-241-3820
Mailing Address - Fax:612-262-6707
Practice Address - Street 1:1460 CURVE CREST BLVD W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6070
Practice Address - Country:US
Practice Address - Phone:651-241-3820
Practice Address - Fax:612-262-6707
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist