Provider Demographics
NPI:1285225532
Name:GRAHAM, DAVID ANDREW
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MANOR WAY APT B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-5483
Mailing Address - Country:US
Mailing Address - Phone:865-255-9836
Mailing Address - Fax:
Practice Address - Street 1:163 MANOR WAY APT B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-5483
Practice Address - Country:US
Practice Address - Phone:865-255-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7427225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant