Provider Demographics
NPI:1801362314
Name:GRAHN, ERIC JOHN (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:GRAHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WHITE OAK WAY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9581
Mailing Address - Country:US
Mailing Address - Phone:630-962-2295
Mailing Address - Fax:
Practice Address - Street 1:655 WHITE OAK WAY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9581
Practice Address - Country:US
Practice Address - Phone:630-962-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4882251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics