Provider Demographics
NPI:1154718138
Name:GRAHAM, JAMI (DPT)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8064 PETERSON RD
Mailing Address - Street 2:
Mailing Address - City:ARENA
Mailing Address - State:WI
Mailing Address - Zip Code:53503-9524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8064 PETERSON RD
Practice Address - Street 2:
Practice Address - City:ARENA
Practice Address - State:WI
Practice Address - Zip Code:53503-9524
Practice Address - Country:US
Practice Address - Phone:217-622-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12891-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist