Individual
MS. KELLY ANN GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, PTA
Contact information
Practice address
1222 S ORANGE AVE, ORLANDO, FL 32806-1215
(321) 841-6444
(407) 650-1307
Mailing address
1222 S ORANGE AVE, ORLANDO, FL 32806-1215
(321) 841-6444
(407) 650-1307
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
26641
FL
363A00000X
Physician Assistant
9112573
FL
363AM0700X
Medical Physician Assistant
Primary
PA112573
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104300400
—
FL
Enumeration date
05/20/2016
Last updated
08/26/2020
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