Provider Demographics
NPI:1326751603
Name:GRAY, SYDNEY (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 BROOKE CV
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0627
Mailing Address - Country:US
Mailing Address - Phone:706-247-4888
Mailing Address - Fax:
Practice Address - Street 1:500 INTERSTATE BLVD S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4634
Practice Address - Country:US
Practice Address - Phone:706-247-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer