Provider Demographics
NPI:1487770392
Name:GRAVES, JAMIE G (PT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:G
Last Name:GRAVES
Suffix:
Gender:F
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:COSMOPOLIS
Mailing Address - State:WA
Mailing Address - Zip Code:98537-0217
Mailing Address - Country:US
Mailing Address - Phone:360-537-9772
Mailing Address - Fax:
Practice Address - Street 1:575 E MAIN ST
Practice Address - Street 2:BUILDING 1, SUITE A
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9551
Practice Address - Country:US
Practice Address - Phone:360-482-5640
Practice Address - Fax:360-482-5132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00008987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist