Individual
KELLY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
400 LEE BLVD, LEHIGH ACRES, FL 33936-6829
(239) 369-9986
(239) 368-0986
Mailing address
400 LEE BLVD, LEHIGH ACRES, FL 33936-4923
(239) 369-9986
(239) 303-9986
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA0023317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2140
BLUE CROSS BLUE SHIELD PROVIDER
FL
Enumeration date
10/29/2008
Last updated
05/03/2011
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