Provider Demographics
NPI:1417563354
Name:GRAAF, ALLENA L (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:ALLENA
Middle Name:L
Last Name:GRAAF
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 SW 127TH TER UNIT A
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6049
Mailing Address - Country:US
Mailing Address - Phone:305-467-6532
Mailing Address - Fax:
Practice Address - Street 1:4603 SW 127TH TER UNIT A
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6049
Practice Address - Country:US
Practice Address - Phone:305-467-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA69931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist