Provider Demographics
NPI:1922344225
Name:GRAHAM, RUTH MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:MARIE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9563 LAGUNA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8204
Mailing Address - Country:US
Mailing Address - Phone:916-691-9822
Mailing Address - Fax:916-691-9448
Practice Address - Street 1:9563 LAGUNA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8204
Practice Address - Country:US
Practice Address - Phone:916-691-9822
Practice Address - Fax:916-691-9448
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT118662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics