Eldon V Graham III, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501021566 Issued in MI

Practice address

3751 S State Rd
Ionia, MI 48846-9478

Phone

(616) 522-0066

Fax

(616) 527-1667

NPI assigned

Dec 18, 2021

Sex

Male

Sole proprietor

No

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)

Enrolled

State licenses

Practice roles

Locations

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.

• Grand River Physical Therapy Specialists PC

  • Physical Therapist
  • Ionia, MI
  • NPI 1356415483
  NPD

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

{
    "created_epoch": "1639785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1750041745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3751 S STATE RD",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488469478",
            "telephone_number": "616-522-0066",
            "fax_number": "616-527-1667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "269 W 16th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100116000",
            "country_code": "US",
            "telephone_number": "646-841-1411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "ELDON",
        "middle_name": "V",
        "name_suffix": "III",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-18",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "048143",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501021566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Lynn Gothberg, NP
• Grace Counseling of Mid-Michigan LLC
• Geoffrey Grace, PHARMD
• Grade-a Family Chiropractic Center
• Timothy Grady, D.C.
• Corey John Grahn, NP-C
• Grand River Physical Therapy Specialists PC
• Wanda J Greenhoe, LBSW
• Rachael Greenman
• Gro Optical, LLC

• Physical Therapist in Ionia, MI
• Providers in Ionia, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.