Provider Demographics
NPI:1073982617
Name:GRAY, SCOTT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
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 1:9724 COMMERCE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3608
Mailing Address - Country:US
Mailing Address - Phone:239-223-0484
Mailing Address - Fax:239-790-0969
Practice Address - Street 1:9724 COMMERCE CENTER CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3608
Practice Address - Country:US
Practice Address - Phone:239-223-0484
Practice Address - Fax:239-790-0969
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist