Gary Lynn Graham Jr., PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

9487 Issued in CA

Practice address

760 Canyon Oaks Dr
Apt C
Oakland, CA 94605-3869

Phone

(901) 619-7031

NPI assigned

Jan 2, 2015

Last updated

Jan 2, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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": "1420156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420156800000",
    "number": "1700274586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 CANYON OAKS DR",
            "address_2": "APT C",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946053869",
            "telephone_number": "901-619-7031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 CANYON OAKS DR",
            "address_2": "APT C",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946053869",
            "telephone_number": "901-619-7031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "GARY",
        "middle_name": "LYNN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-02",
        "last_updated": "2015-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "4821",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "9487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Gower
• Raghav Kumar Goyal, MD
• Iva Grabic
• Raul Mark Miranda Grageda
• Stephon Nicholas Brown Graham Schaller
• Lauren Graham, SLPA
• Lorenzo Graham
• Richard S Graham, MD
• Steven Riester Graham, ASW
• Chris Grajeda

• Physical Therapy Assistant in Oakland, CA
• Providers in Oakland, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.