Provider Demographics
NPI:1154536415
Name:GRAHAM, TERRY LEE (PT)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3371
Mailing Address - Country:US
Mailing Address - Phone:206-709-9662
Mailing Address - Fax:206-323-0773
Practice Address - Street 1:3317 E UNION ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3371
Practice Address - Country:US
Practice Address - Phone:206-709-9662
Practice Address - Fax:206-323-0773
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist