Provider Demographics
NPI:1447776216
Name:GRAY, EBONI (DPT)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7057
Mailing Address - Country:US
Mailing Address - Phone:972-824-2033
Mailing Address - Fax:
Practice Address - Street 1:7150 N GEORGE BUSH HWY STE 103
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2209
Practice Address - Country:US
Practice Address - Phone:972-497-2819
Practice Address - Fax:972-408-0879
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist