Provider Demographics
NPI:1093424269
Name:MCCRAY, DOUGLAS KEITH II (LMT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:KEITH
Last Name:MCCRAY
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19132 GRANDVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2743
Mailing Address - Country:US
Mailing Address - Phone:313-784-6981
Mailing Address - Fax:
Practice Address - Street 1:19132 GRANDVILLE AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2743
Practice Address - Country:US
Practice Address - Phone:313-784-6981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI22271040901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist