Provider Demographics
NPI:1194781963
Name:GRAVES, STEVEN MICHAEL (ATC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:GRAVES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 VICTORIA PL
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5320
Mailing Address - Country:US
Mailing Address - Phone:909-625-7261
Mailing Address - Fax:
Practice Address - Street 1:500 E 9TH ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5929
Practice Address - Country:US
Practice Address - Phone:909-607-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer