Provider Demographics
NPI:1649663576
Name:GRAHAM, BRITTANY (MBA, ATC, LAT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MBA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50147-2015
Mailing Address - Country:US
Mailing Address - Phone:641-344-0909
Mailing Address - Fax:
Practice Address - Street 1:620 E 8TH ST
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:IA
Practice Address - Zip Code:50147-2015
Practice Address - Country:US
Practice Address - Phone:641-344-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20000193942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer