Active NPI
Charles P. Graham, P.T.A.
- Physical Therapy Assistant
- Columbia, SC
National Provider Identifier
1154785178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3475
- Practice address
- 115 Blarney Drive
Suite 202
Columbia, SC 29223 - Phone
- (803) 736-4845
- Fax
- (803) 736-8674
- NPI assigned
- Apr 6, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 3475 | SC | Primary |
Addresses
Primary practice location
115 Blarney Drive
Suite 202
Columbia, SC 29223
Mailing address
115 Blarney Drive, Suite 202
Columbia Rehabilitation Clinic, Inc.
Columbia, SC 29223
Phone (803) 736-4845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3475 | SC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbia Rehabilitation Clinic | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Columbia, SC
- NPI 1164404711
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459900800000",
"number": "1154785178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 BLARNEY DRIVE, SUITE 202",
"address_2": "COLUMBIA REHABILITATION CLINIC, INC.",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29223",
"telephone_number": "803-736-4845",
"fax_number": "803-736-8674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 BLARNEY DRIVE",
"address_2": "SUITE 202",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29223",
"telephone_number": "803-736-4845",
"fax_number": "803-736-8674"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "CHARLES",
"middle_name": "P.",
"name_prefix": "Mr.",
"credential": "P.T.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-06",
"last_updated": "2016-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SC",
"license": "3475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.