Provider Demographics
NPI:1831459882
Name:GRAVES, MARIE E (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:E
Other - Last Name:HENKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7567 CENTRAL PARKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6855
Mailing Address - Country:US
Mailing Address - Phone:513-701-6100
Mailing Address - Fax:513-701-6106
Practice Address - Street 1:600 MEIJER DR STE 104
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4878
Practice Address - Country:US
Practice Address - Phone:859-538-1165
Practice Address - Fax:859-538-1164
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-006040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01157277Medicare PIN