Provider Demographics
NPI:1457482481
Name:GRAY, ELIZABETH DALEY (LMP, PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:DALEY
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 MERIDIAN AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6139
Mailing Address - Country:US
Mailing Address - Phone:206-547-4064
Mailing Address - Fax:206-417-9744
Practice Address - Street 1:5404 MERIDIAN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6139
Practice Address - Country:US
Practice Address - Phone:206-547-4064
Practice Address - Fax:206-417-9744
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist