Provider Demographics
NPI:1447680681
Name:GRAHAM, MATTHEW KENT (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KENT
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 DOLSTON COURT NW
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112
Mailing Address - Country:US
Mailing Address - Phone:740-654-0641
Mailing Address - Fax:
Practice Address - Street 1:3680 DOLSTON COURT NW
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112
Practice Address - Country:US
Practice Address - Phone:740-654-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist