Individual
REBECCA MARIE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1126 DODGE AVE, FORT WAYNE, IN 46805-3530
(260) 413-0974
Mailing address
1126 DODGE AVE, FORT WAYNE, IN 46805-3530
(260) 413-0974
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002651A
IN
Other
Enumeration date
06/06/2011
Last updated
06/06/2011
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