Provider Demographics
NPI:1407416589
Name:GRAEME, HEATHER LEE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:GRAEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 31ST ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-1000
Mailing Address - Country:US
Mailing Address - Phone:727-643-3318
Mailing Address - Fax:727-906-0150
Practice Address - Street 1:235 31ST ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1000
Practice Address - Country:US
Practice Address - Phone:727-643-3318
Practice Address - Fax:727-906-0150
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty