Individual
KELLY GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 CUSTIS RD, GLENSIDE, PA 19038-2013
(215) 939-2474
Mailing address
601 CUSTIS RD, GLENSIDE, PA 19038-2013
(215) 939-2474
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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