Provider Demographics
NPI:1861484305
Name:GRAFA, COLLEEN S (PT,MS,DSC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:S
Last Name:GRAFA
Suffix:
Gender:F
Credentials:PT,MS,DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5056
Mailing Address - Country:US
Mailing Address - Phone:903-891-8222
Mailing Address - Fax:
Practice Address - Street 1:220 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5056
Practice Address - Country:US
Practice Address - Phone:903-891-8222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8211B6Medicare ID - Type Unspecified
TXP58241Medicare UPIN