Provider Demographics
NPI:1033116538
Name:GRAY, DEMARAH BACKUS (MS, PT)
Entity Type:Individual
Prefix:
First Name:DEMARAH
Middle Name:BACKUS
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HANSON ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3607
Mailing Address - Country:US
Mailing Address - Phone:775-625-2222
Mailing Address - Fax:775-625-1131
Practice Address - Street 1:325 HANSON ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3607
Practice Address - Country:US
Practice Address - Phone:775-625-2222
Practice Address - Fax:775-625-1131
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV33552Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER