Individual
PENNY L GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2109 HERNDON ST, DOVER, FL 33527-6349
(813) 404-4142
Mailing address
2109 HERNDON ST, DOVER, FL 33527-6349
(813) 404-4142
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
11/04/2006
Last updated
07/08/2007
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