Kelly Graham, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA0023317 Issued in FL

Practice address

400 Lee Blvd
Lehigh Acres, FL 33936-6829

Phone

(239) 369-9986

Fax

(239) 368-0986

NPI assigned

Oct 29, 2008

Last updated

May 3, 2011By the provider in NPPES

Sex

Female

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304380800000",
    "number": "1255584603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 LEE BLVD",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339364923",
            "telephone_number": "239-369-9986",
            "fax_number": "239-303-9986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 LEE BLVD",
            "city": "LEHIGH ACRES",
            "state": "FL",
            "postal_code": "339366829",
            "telephone_number": "239-369-9986",
            "fax_number": "239-368-0986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KELLY",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-29",
        "last_updated": "2011-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA0023317",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD PROVIDER",
            "identifier": "C2140",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Lehigh Acres, FL
• Providers in Lehigh Acres, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; 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.