Provider Demographics
NPI:1104153915
Name:GRAHAM, ROBIN MICHELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MICHELLE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6470
Mailing Address - Country:US
Mailing Address - Phone:405-324-0961
Mailing Address - Fax:405-324-0971
Practice Address - Street 1:1707 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6470
Practice Address - Country:US
Practice Address - Phone:405-324-0961
Practice Address - Fax:405-324-0971
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA480225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant