Provider Demographics
NPI:1679612063
Name:GRAHAM, CINDY LOUISE (LMT,CMT,NCTMB)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LOUISE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:LMT,CMT,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E BOONESLICK RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-2004
Mailing Address - Country:US
Mailing Address - Phone:636-456-1861
Mailing Address - Fax:636-456-5972
Practice Address - Street 1:102 E BOONESLICK RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-2004
Practice Address - Country:US
Practice Address - Phone:636-456-1861
Practice Address - Fax:636-456-5972
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006036403225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist