Provider Demographics
NPI:1659755858
Name:GRAVES, EMMA CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:CHRISTINE
Last Name:GRAVES
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 1:55 CENTRAL IOWA DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5983
Mailing Address - Country:US
Mailing Address - Phone:641-754-6120
Mailing Address - Fax:641-754-6154
Practice Address - Street 1:55 CENTRAL IOWA DR
Practice Address - Street 2:SUITE 340
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5983
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:641-754-6154
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB3481Medicare PIN
IAIB3481017Medicare PIN