Provider Demographics
NPI:1801427380
Name:GRAHEK, JOSEPH JOHN (CMT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:GRAHEK
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 FREEWAY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-1765
Mailing Address - Country:US
Mailing Address - Phone:612-747-0220
Mailing Address - Fax:
Practice Address - Street 1:2781 FREEWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-1765
Practice Address - Country:US
Practice Address - Phone:612-747-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1619413655OtherOTHER