Provider Demographics
NPI:1902455488
Name:TAYLOR-GRAHAM, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:TAYLOR-GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 CARSON DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-5410
Mailing Address - Country:US
Mailing Address - Phone:540-553-1633
Mailing Address - Fax:
Practice Address - Street 1:980 CARSON DR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-5410
Practice Address - Country:US
Practice Address - Phone:540-553-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty