Provider Demographics
NPI:1376536250
Name:CARDOSA GRAY, ANNA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:CARDOSA GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:L
Other - Last Name:CARDOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4948 W PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3530
Mailing Address - Country:US
Mailing Address - Phone:623-512-6156
Mailing Address - Fax:800-915-4197
Practice Address - Street 1:2302 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1201
Practice Address - Country:US
Practice Address - Phone:623-242-6908
Practice Address - Fax:623-242-6909
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT61912251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ811415OtherARIZONA HEATHCARE COST CONTAINMENT SYSTEM (AHCCCS)