Individual
MR. GARY LYNN GRAHAM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
760 CANYON OAKS DR, APT C, OAKLAND, CA 94605-3869
(901) 619-7031
Mailing address
760 CANYON OAKS DR, APT C, OAKLAND, CA 94605-3869
(901) 619-7031
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
4821
TN
225200000X
Physical Therapy Assistant
Primary
9487
CA
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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