Active NPI
Justin Graham
- Physical Therapist
- Winston Salem, NC
National Provider Identifier
1821862517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P22758
- Practice address
- 190 Kimel Park Dr Ste 139
Winston Salem, NC 27103-6946 - Phone
- (336) 718-6931
- NPI assigned
- Nov 13, 2023
- Sex
- Male
- 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 | P22758 | NC | Primary |
Addresses
Primary practice location
190 Kimel Park Dr Ste 139
Winston Salem, NC 27103-6946
Mailing address
2108 Enterprise Rd
Lexington, NC 27295-7319
Phone (336) 655-9363
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 |
|---|---|---|---|
| P22758 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699833600000",
"number": "1821862517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2108 ENTERPRISE RD",
"city": "LEXINGTON",
"state": "NC",
"postal_code": "272957319",
"telephone_number": "336-655-9363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 KIMEL PARK DR STE 139",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271036946",
"telephone_number": "336-718-6931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-13",
"last_updated": "2023-11-13",
"certification_date": "2023-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P22758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
- Ayana Laura Graham, DPT
- Brianna Graham, RBT
- Charles Alan Graham, DC
- Crystal Shamar Graham, LCAS
- Gary Michael Graham, CRNA
- Sarah Bradford McCollum Graham, PA
- Valerie Wyke Granade, PT
- Courtney Haldeman Granadero, AGNP
- Grand Prairie Healthcare Services, P.C.
- Grandfather Home Community Services for Children
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.