Basic Information
| Provider Information | |||||||||
| NPI: | 1770586455 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAFF | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32490 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850642490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022304478 | ||||||||
| FaxNumber: | 6022309962 | ||||||||
| Practice Location | |||||||||
| Address1: | 4232 E CACTUS RD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850327611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029969949 | ||||||||
| FaxNumber: | 6029966760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6594 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 919897 | 05 | AZ | MEDICAID |