Provider Demographics
NPI:1457486813
Name:GRAY, COURTNEY (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 DANBY RD
Mailing Address - Street 2:HILL CENTER TRAINING ROOM, ITHACA COLLEGE
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-7000
Mailing Address - Country:US
Mailing Address - Phone:607-274-3120
Mailing Address - Fax:
Practice Address - Street 1:953 DANBY RD
Practice Address - Street 2:HILL CENTER TRAINING ROOM, ITHACA COLLEGE
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-7000
Practice Address - Country:US
Practice Address - Phone:607-274-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000954-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer