Provider Demographics
NPI:1619034808
Name:GRAFF, MARIAN (PT)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:GRAFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18215 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3609
Mailing Address - Country:US
Mailing Address - Phone:708-444-2563
Mailing Address - Fax:708-444-2769
Practice Address - Street 1:18215 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3609
Practice Address - Country:US
Practice Address - Phone:708-444-2563
Practice Address - Fax:708-444-2769
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IL070011589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-011589OtherPT STATE LICENSE #
IL146636Medicare ID - Type Unspecified