Vicki Melissa Graham, P.T.
Individual provider Active NPI Physical Therapist · Clyde, TX
NPI 1376660209 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376660209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1099463 (TX)
- Practice address
- 2218 Castle Dr
Clyde, TX 79510-3404 - Phone
- (325) 893-2093
- Fax
- (325) 893-4644
- NPI assigned
- Mar 24, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1099463 | TX | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1099463 | TX | Yes |
Addresses
Primary practice location
2218 Castle Dr
Clyde, TX 79510-3404
Mailing address
2218 Castle Dr
Clyde, TX 79510-3404
Phone (325) 893-2093
Other providers in Clyde, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.