Individual
GINA GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
540 KINGSLEY AVE, ORANGE PARK, FL 32073-4847
(904) 264-2156
Mailing address
611 RACOON CT, JACKSONVILLE, FL 32259-1912
(904) 287-4569
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL947
FL
Other
Enumeration date
09/30/2006
Last updated
07/08/2007
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