Provider Demographics
NPI:1740657444
Name:GRAHAM PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:GRAHAM PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-490-6811
Mailing Address - Street 1:247 MARKET ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5317
Mailing Address - Country:US
Mailing Address - Phone:310-490-6811
Mailing Address - Fax:
Practice Address - Street 1:1 LMU DR
Practice Address - Street 2:ATHLETIC DEPARTMENT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2650
Practice Address - Country:US
Practice Address - Phone:310-995-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23979261QP2000X
CAPT23946261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy