Provider Demographics
NPI:1497012074
Name:GRAHAM, DEBORAH V (LCPO)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:V
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0283
Mailing Address - Country:US
Mailing Address - Phone:817-877-0294
Mailing Address - Fax:817-877-0304
Practice Address - Street 1:1719 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1349
Practice Address - Country:US
Practice Address - Phone:682-885-6294
Practice Address - Fax:682-885-1135
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist