Provider Demographics
NPI:1407946924
Name:GRAY, RAY (RPT)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W. PALMDALE BLVD SUITE F
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 W PALMDALE BLVD
Practice Address - Street 2:STE F
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3104
Practice Address - Country:US
Practice Address - Phone:661-273-5333
Practice Address - Fax:661-273-0033
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11047Medicare ID - Type UnspecifiedMEDICARE ID