Provider Demographics
NPI:1255714788
Name:GRAHAM, CHESTER (PT)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41315 EMERALDA ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-8337
Mailing Address - Country:US
Mailing Address - Phone:352-669-5632
Mailing Address - Fax:
Practice Address - Street 1:3260 WATERMAN WAY
Practice Address - Street 2:HOME CARE SERVICES
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5243
Practice Address - Country:US
Practice Address - Phone:352-253-3900
Practice Address - Fax:352-253-3895
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist