Active NPI
Tracy Graham, PT, DPT
- Physical Therapist
- Keego Harbor, MI
National Provider Identifier
1407337736
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501015841
- Practice address
- 2141 Cass Lake Rd Ste 105
Keego Harbor, MI 48320-1270 - Phone
- (248) 388-1362
- NPI assigned
- Aug 24, 2018
- Sex
- Female
- 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 Therapist | 225100000X | 5501015841 | MI | Primary |
Addresses
Primary practice location
2141 Cass Lake Rd Ste 105
Keego Harbor, MI 48320-1270
Mailing address
9760 Mandon Rd
White Lake, MI 48386-2949
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 |
|---|---|---|---|
| 5501015841 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Next Level Home Therapy Services | Physical Therapist | 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.
-
- Physical Therapist
- White Lake, MI
- NPI 1366899205
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535068800000",
"number": "1407337736",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9760 MANDON RD",
"city": "WHITE LAKE",
"state": "MI",
"postal_code": "483862949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2141 CASS LAKE RD STE 105",
"city": "KEEGO HARBOR",
"state": "MI",
"postal_code": "483201270",
"telephone_number": "248-388-1362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "TRACY",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-24",
"last_updated": "2018-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501015841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keego Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.