Provider Demographics
NPI:1376620583
Name:GRAY, MARCI JENNIFER (PT)
Entity Type:Individual
Prefix:MS
First Name:MARCI
Middle Name:JENNIFER
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 1:2920 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4408
Mailing Address - Country:US
Mailing Address - Phone:850-999-1888
Mailing Address - Fax:850-999-1895
Practice Address - Street 1:2920 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4408
Practice Address - Country:US
Practice Address - Phone:850-999-1888
Practice Address - Fax:850-999-1895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBG290ZMedicare PIN