Provider Demographics
NPI:1407865397
Name:GRAY, JENNIFER RAE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RAE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PTA
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Mailing Address - Street 1:5214 S EAST STREET
Mailing Address - Street 2:BUILDING D SUITE 1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-780-3750
Practice Address - Street 1:5214 S EAST STREET
Practice Address - Street 2:BUILDING D SUITE 1 HTS OUTPATIENT THERAPY SERVICES
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-780-3750
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN06002758A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant