Individual
KEITH ALLEN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC/L
Contact information
Practice address
8 MEDICAL PARK DRIVE, SUITE 100, MALTA, NY 12020
(518) 363-8710
Mailing address
8 MEDICAL PARK DRIVE, SUITE 100, MALTA, NY 12020
(518) 363-8710
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003760-1
NY
2255A2300X
Athletic Trainer
104.0000102
VT
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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