Basic Information
| Provider Information | |||||||||
| NPI: | 1134659766 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GRAVES | ||||||||
| FirstName: | ERIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 OLIVE CHAPEL RD STE 103 | ||||||||
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| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275028587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195358758 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21453 EPICERIE PLZ STE 100 | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201646648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036628151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2017 | ||||||||
| LastUpdateDate: | 06/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305211098 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.