Provider Demographics
NPI:1891825998
Name:GRAHAM, CASEY R (ATC)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:R
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 118
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16340-9309
Mailing Address - Country:US
Mailing Address - Phone:814-688-5160
Mailing Address - Fax:
Practice Address - Street 1:1 PARK PL
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2085
Practice Address - Country:US
Practice Address - Phone:607-735-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0014822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer