Provider Demographics
NPI:1275857740
Name:GRAY, ANNEMARIE COUGHLIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNEMARIE
Middle Name:COUGHLIN
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1854
Mailing Address - Country:US
Mailing Address - Phone:865-524-0054
Mailing Address - Fax:865-966-0191
Practice Address - Street 1:90 VERMONT AVE STE 301
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6478
Practice Address - Country:US
Practice Address - Phone:865-482-2390
Practice Address - Fax:865-482-2347
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT 00000014582251X0800X
TN1458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ051657Medicaid