Provider Demographics
NPI:1245814888
Name:GRAHAM, JOANIE LASHELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:JOANIE
Middle Name:LASHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:JOANIE
Other - Middle Name:LASHELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4251 UNIVERSITY BLVD S STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4974
Mailing Address - Country:US
Mailing Address - Phone:904-305-2115
Mailing Address - Fax:
Practice Address - Street 1:4251 UNIVERSITY BLVD S STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4974
Practice Address - Country:US
Practice Address - Phone:904-305-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA86693225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist