Provider Demographics
NPI:1689911729
Name:GRAHAM-LEWIS, GINGER V (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:GINGER
Middle Name:V
Last Name:GRAHAM-LEWIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8186 LARK BROWN RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6433
Mailing Address - Country:US
Mailing Address - Phone:410-799-4232
Mailing Address - Fax:
Practice Address - Street 1:8186 LARK BROWN RD
Practice Address - Street 2:SUITE 302
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6433
Practice Address - Country:US
Practice Address - Phone:410-799-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist