Provider Demographics
NPI:1407374945
Name:MCGRAW, KATHLEEN MARTIN (ATC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARTIN
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1040 GULF BREEZE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-7808
Mailing Address - Country:US
Mailing Address - Phone:850-916-8673
Mailing Address - Fax:
Practice Address - Street 1:1040 GULF BREEZE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7808
Practice Address - Country:US
Practice Address - Phone:850-916-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL27472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer