Provider Demographics
NPI:1689058620
Name:GRAHAM, ARLENE (LMT 7318)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMT 7318
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MOUNTAIN RD NE
Mailing Address - Street 2:APT 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2374
Mailing Address - Country:US
Mailing Address - Phone:505-373-4179
Mailing Address - Fax:
Practice Address - Street 1:213 MOUNTAIN RD NE
Practice Address - Street 2:APT 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2374
Practice Address - Country:US
Practice Address - Phone:505-373-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist