Provider Demographics
NPI:1740552876
Name:GRAYDON, NANCY SUNNY (LMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUNNY
Last Name:GRAYDON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 EAGLE VIEW DR APT F
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35212-4222
Mailing Address - Country:US
Mailing Address - Phone:334-300-6952
Mailing Address - Fax:
Practice Address - Street 1:1901 RICHARD ARRINGTON JR BLVD S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-1270
Practice Address - Country:US
Practice Address - Phone:334-300-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6406225700000X
AL2547225700000X
GA007561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist