Individual
SARAH JO GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
457 S FITNESS PL, SUITE 100, EAGLE, ID 83616-6568
(208) 939-3332
(208) 939-3338
Mailing address
278 S NESKOWIN WAY, EAGLE, ID 83616-4964
(208) 939-8176
(208) 939-3338
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-1804
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010144132
HEALTHSENSE 65/ MED ADVAN
ID
01
—
11347662
FIRST HEALTH NETWORK
ID
05
—
806671700
—
ID
01
—
T7697
TRUE BLUE
ID
Enumeration date
08/18/2006
Last updated
07/08/2007
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