Provider Demographics
NPI:1386801645
Name:GRAHAM, DOROTHY C (PT)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:C
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:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08855-0006
Mailing Address - Country:US
Mailing Address - Phone:954-263-0820
Mailing Address - Fax:
Practice Address - Street 1:120 CENTENNIAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3900
Practice Address - Country:US
Practice Address - Phone:732-885-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA03632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic