Provider Demographics
NPI:1821047903
Name:GANDEE, GRAHAM C
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:C
Last Name:GANDEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 HIGHLAND PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3546
Mailing Address - Country:US
Mailing Address - Phone:859-623-4567
Mailing Address - Fax:888-474-7740
Practice Address - Street 1:370 HIGHLAND PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3546
Practice Address - Country:US
Practice Address - Phone:859-623-4567
Practice Address - Fax:888-474-7740
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5027509Medicare ID - Type UnspecifiedMEDICARE #