Provider Demographics
NPI:1124657705
Name:GRAHAM, COREY KENDALL (PT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:KENDALL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W HUDSON RD
Mailing Address - Street 2:STE 3
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2181
Mailing Address - Country:US
Mailing Address - Phone:407-479-2015
Mailing Address - Fax:
Practice Address - Street 1:2100 W HUDSON RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2102
Practice Address - Country:US
Practice Address - Phone:479-340-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist