Provider Demographics
NPI:1982893756
Name:GRAHAM, PEGGY DIANNA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:DIANNA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:PEGGY
Other - Middle Name:DIANE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:3021 HELGESON LANE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-218-7327
Mailing Address - Fax:
Practice Address - Street 1:3021 HELGESON LANE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-218-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3781225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist