Provider Demographics
NPI:1225271562
Name:GRAY, JENNIFER MANN (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MANN
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S MEBANE ST APT 109
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5999
Mailing Address - Country:US
Mailing Address - Phone:336-229-0597
Mailing Address - Fax:
Practice Address - Street 1:2680 SOUTH MEBANE ST. APT 109
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9415
Practice Address - Country:US
Practice Address - Phone:336-227-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12039225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist