Provider Demographics
NPI:1144359167
Name:GRAHAM, SUZANNE F (PT)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:F
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:FRANCAVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:18 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-3502
Mailing Address - Country:US
Mailing Address - Phone:908-246-0701
Mailing Address - Fax:
Practice Address - Street 1:18 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804-3502
Practice Address - Country:US
Practice Address - Phone:908-246-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00520600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist