Provider Demographics
NPI:1407063316
Name:CRAY, SHAWN (DPT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:CRAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 WASHINGTON ST
Mailing Address - Street 2:APT 9
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2033
Mailing Address - Country:US
Mailing Address - Phone:339-987-4856
Mailing Address - Fax:339-987-4858
Practice Address - Street 1:1681 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7948
Practice Address - Country:US
Practice Address - Phone:339-987-4856
Practice Address - Fax:339-987-4858
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000061302Medicare PIN