Provider Demographics
NPI:1487841524
Name:GRAVES, TONY OMAR (PT)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:OMAR
Last Name:GRAVES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 ARBORETUM PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3472
Mailing Address - Country:US
Mailing Address - Phone:804-915-4602
Mailing Address - Fax:804-327-8496
Practice Address - Street 1:5899 BREMO RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1935
Practice Address - Country:US
Practice Address - Phone:804-285-2645
Practice Address - Fax:804-287-2786
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052047652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic