Provider Demographics
NPI:1174927487
Name:DAVIS, GRAHAM PHILLIPS (LMT)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:PHILLIPS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 E GRAYSTONE WAY
Mailing Address - Street 2:GRAYSTONE HEALTH AND PROFESSIONAL BUILDING
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2673
Mailing Address - Country:US
Mailing Address - Phone:801-889-3944
Mailing Address - Fax:
Practice Address - Street 1:1174 E GRAYSTONE WAY
Practice Address - Street 2:GRAYSTONE HEALTH AND PROFESSIONAL BUILDING
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2673
Practice Address - Country:US
Practice Address - Phone:801-889-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8489516-4701173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist