Provider Demographics
NPI:1386758464
Name:GRAHAM, SARAH JO (MPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JO
Other - Last Name:LUGINBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:278 S NESKOWIN WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4964
Mailing Address - Country:US
Mailing Address - Phone:208-939-8176
Mailing Address - Fax:208-939-3338
Practice Address - Street 1:457 S FITNESS PL
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6568
Practice Address - Country:US
Practice Address - Phone:208-939-3332
Practice Address - Fax:208-939-3338
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-1804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010144132OtherHEALTHSENSE 65/ MED ADVAN
ID11347662OtherFIRST HEALTH NETWORK
IDT7697OtherTRUE BLUE
IDT7697OtherHMO BLUE
ID000010144132OtherBLUE SHIELD
ID806671700Medicaid
IDT7697OtherBLUE CROSS