Provider Demographics
NPI:1851525554
Name:GRAHAM, KATHERINE SUE (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:SUE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 N BRAND BLVD
Mailing Address - Street 2:593
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2609
Mailing Address - Country:US
Mailing Address - Phone:818-434-7103
Mailing Address - Fax:
Practice Address - Street 1:249 N BRAND BLVD
Practice Address - Street 2:593
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2609
Practice Address - Country:US
Practice Address - Phone:818-434-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19484225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist