Provider Demographics
NPI:1538375472
Name:GRAVES, DUANE ROBERT (MPT)
Entity type:Individual
Prefix:MR
First Name:DUANE
Middle Name:ROBERT
Last Name:GRAVES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18440 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:NEW LOTHROP
Mailing Address - State:MI
Mailing Address - Zip Code:48460-9637
Mailing Address - Country:US
Mailing Address - Phone:810-638-4259
Mailing Address - Fax:810-638-4259
Practice Address - Street 1:2500 N ELMS RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9426
Practice Address - Country:US
Practice Address - Phone:810-342-5550
Practice Address - Fax:810-342-5589
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist