Provider Demographics
NPI:1205055647
Name:GRAVES, NATALIE PAGE (PT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:PAGE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 MARIAN DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6709
Mailing Address - Country:US
Mailing Address - Phone:812-886-5891
Mailing Address - Fax:
Practice Address - Street 1:1201 MAIN ST.
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:IN
Practice Address - Zip Code:47557
Practice Address - Country:US
Practice Address - Phone:812-743-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002209A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232620BMedicare ID - Type Unspecified