Provider Demographics
NPI:1164604815
Name:GRAY, TAMMY L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639353
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9353
Mailing Address - Country:US
Mailing Address - Phone:812-537-8241
Mailing Address - Fax:812-537-1041
Practice Address - Street 1:1035 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:VEVAY
Practice Address - State:IN
Practice Address - Zip Code:47043-9125
Practice Address - Country:US
Practice Address - Phone:812-427-0293
Practice Address - Fax:812-427-0188
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009410A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist