Provider Demographics
NPI:1861640005
Name:GRAVES, CHRISTIE DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:DAWN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BRUCETON
Mailing Address - State:TN
Mailing Address - Zip Code:38317-1507
Mailing Address - Country:US
Mailing Address - Phone:731-586-3545
Mailing Address - Fax:
Practice Address - Street 1:120 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BRUCETON
Practice Address - State:TN
Practice Address - Zip Code:38317-1507
Practice Address - Country:US
Practice Address - Phone:731-586-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2953225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant