Provider Demographics
NPI:1407085632
Name:GRAHE, BRIAN M (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:M
Last Name:GRAHE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4301
Mailing Address - Country:US
Mailing Address - Phone:410-686-8922
Mailing Address - Fax:410-686-8923
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4301
Practice Address - Country:US
Practice Address - Phone:410-686-8922
Practice Address - Fax:410-686-8923
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD22940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist