Individual
RUSSELL P GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 NORTH ROAD, NORTH YARMOUTH, ME 04097
(207) 239-6625
Mailing address
1500 NORTH ROAD, NORTH YARMOUTH, ME 04097
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HP5800824-02
PERSONAL INSURANCE
—
Enumeration date
09/28/2020
Last updated
09/28/2020
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