Provider Demographics
NPI:1033242151
Name:GRAY, GARY WYNN (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WYNN
Last Name:GRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W US 223
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8439
Mailing Address - Country:US
Mailing Address - Phone:517-263-3378
Mailing Address - Fax:517-263-4527
Practice Address - Street 1:1800 W US 223
Practice Address - Street 2:SUITE 100
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8439
Practice Address - Country:US
Practice Address - Phone:517-263-3378
Practice Address - Fax:517-263-4527
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist