Provider Demographics
NPI:1164532016
Name:GRAY, JEREMY
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DEWSBURY DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-2744
Mailing Address - Country:US
Mailing Address - Phone:615-225-8385
Mailing Address - Fax:931-685-5578
Practice Address - Street 1:845 UNION ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2607
Practice Address - Country:US
Practice Address - Phone:931-685-5575
Practice Address - Fax:931-685-5578
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5337558OtherLICENSURE
ALPTH2797OtherLICENSE #