Kevin P Graham, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00003966 Issued in WA

Practice address

9514 4TH St NE
Suite 101
Lake Stevens, WA 98258-1937

Phone

(425) 397-2327

Fax

(425) 377-0283

NPI assigned

Feb 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1205977386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 19TH AVE SE",
            "address_2": "SUITE B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084280",
            "telephone_number": "408-570-0510",
            "fax_number": "408-945-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9514 4TH ST NE",
            "address_2": "SUITE 101",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982581937",
            "telephone_number": "425-397-2327",
            "fax_number": "425-377-0283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KEVIN",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00003966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8340184",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.