Provider Demographics
NPI:1114174901
Name:GRAVES, KARLENA
Entity type:Individual
Prefix:MRS
First Name:KARLENA
Middle Name:
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HUME
Mailing Address - State:IL
Mailing Address - Zip Code:61932-7237
Mailing Address - Country:US
Mailing Address - Phone:217-887-2545
Mailing Address - Fax:217-269-2108
Practice Address - Street 1:66 FRONT ST
Practice Address - Street 2:
Practice Address - City:HUME
Practice Address - State:IL
Practice Address - Zip Code:61932-7237
Practice Address - Country:US
Practice Address - Phone:217-887-2545
Practice Address - Fax:217-269-2108
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16003742225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant