Provider Demographics
NPI:1396032710
Name:GRAY, ANNIE K (PT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:K
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:P.O. BOX 220
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224-9207
Mailing Address - Country:US
Mailing Address - Phone:207-562-8048
Mailing Address - Fax:207-562-7179
Practice Address - Street 1:94 WELD ST
Practice Address - Street 2:
Practice Address - City:DIXFIELD
Practice Address - State:ME
Practice Address - Zip Code:04224-9207
Practice Address - Country:US
Practice Address - Phone:207-562-8048
Practice Address - Fax:207-562-7179
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist