Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1313143 | TX |
NPI | 1013474147 |
---|---|
Provider Name | Emily Graham |
First Address | Austin, TX 78729-1912 |
Second Address | Austin, TX 78748-6267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2019 |
Last Update Date | 25/02/2019 |