Provider Demographics
NPI:1891322301
Name:GRAHAM, MARTHA (LMT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 FRANKFURT RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5584
Mailing Address - Country:US
Mailing Address - Phone:423-310-4894
Mailing Address - Fax:
Practice Address - Street 1:6333 FRANKFURT RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5584
Practice Address - Country:US
Practice Address - Phone:419-266-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist