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Individual

MARK LARON GRAHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPTA

Contact information

Practice address
5617 W SILVERLEAF LN, BROWN DEER, WI 53223-1656
(414) 704-8880
Mailing address
5617 W SILVERLEAF LN, BROWN DEER, WI 53223-1656
(414) 704-8880

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
808-019
WI

Other

Enumeration date
05/08/2008
Last updated
05/08/2008
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