Provider Demographics
NPI:1568055580
Name:GRABER, JALON LEE (SPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JALON
Middle Name:LEE
Last Name:GRABER
Suffix:
Gender:M
Credentials:SPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:787 S 700 E
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-5562
Mailing Address - Country:US
Mailing Address - Phone:812-787-1642
Mailing Address - Fax:
Practice Address - Street 1:1800 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47722-1000
Practice Address - Country:US
Practice Address - Phone:812-787-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20000405642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer