Provider Demographics
NPI:1467821975
Name:GRAHAM, CARI (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CARI
Other - Middle Name:
Other - Last Name:SMOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:
Practice Address - Street 1:4612 PRAIRIE PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7971
Practice Address - Country:US
Practice Address - Phone:319-859-8139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist