Individual
MR. JASON MICHAEL GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
12499 UNIVERSITY AVE STE 210, CLIVE, IA 50325-8288
(515) 240-2676
Mailing address
5724 CLARK BLVD, DES MOINES, IA 50311-2052
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-00667
KS
Other
Enumeration date
03/02/2011
Last updated
06/02/2021
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