Provider Demographics
NPI:1912110354
Name:GRAHAM, KRISTEN DOROTHY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:DOROTHY
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:DOROTHY
Other - Last Name:LAMERDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:607 NIGHTINGALE WAY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95692
Mailing Address - Country:US
Mailing Address - Phone:530-633-2278
Mailing Address - Fax:530-633-2278
Practice Address - Street 1:366 ELM AVENUE
Practice Address - Street 2:SUITE 252
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:916-367-1888
Practice Address - Fax:916-729-1611
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist