Provider Demographics
NPI:1962603464
Name:GRAHAM, TROY GABRIEL (PT)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:GABRIEL
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 ALWARD RD
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9244
Mailing Address - Country:US
Mailing Address - Phone:517-651-6128
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1291
Practice Address - Country:US
Practice Address - Phone:989-723-8666
Practice Address - Fax:989-725-1434
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist