Provider Demographics
NPI:1659846764
Name:GRAHAM, EMMA TIEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:TIEN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8605 LUCIANO CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-6367
Mailing Address - Country:US
Mailing Address - Phone:916-761-8896
Mailing Address - Fax:
Practice Address - Street 1:421 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1909
Practice Address - Country:US
Practice Address - Phone:760-747-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT293613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist