| NPI | 1417094095 |
|---|---|
| Former Name | SHANA LYNN GRAHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MS PTA3102) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS PTA3102) |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-04-07 |