Provider Demographics
NPI:1922414267
Name:BAXTER, GRAIG MICHAEL
Entity Type:Individual
Prefix:MR
First Name:GRAIG
Middle Name:MICHAEL
Last Name:BAXTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SQUAREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1868
Mailing Address - Country:US
Mailing Address - Phone:585-749-1784
Mailing Address - Fax:
Practice Address - Street 1:124 SQUAREVIEW LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1868
Practice Address - Country:US
Practice Address - Phone:585-749-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist