Individual
MARK C GRAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
870 N ELLINGTON PKWY, LEWISBURG, TN 37091-2271
(931) 361-4023
(931) 361-4024
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 954-7408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8683
TN
2255A2300X
Athletic Trainer
889
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8683
PHYSICAL THERAPY LICENSE
TN
Enumeration date
02/28/2007
Last updated
01/31/2014
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