Provider Demographics
NPI:1477700193
Name:GRAY, REBECCA J (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:WEHMUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5835 HARBOUR VIEW BLVD
Mailing Address - Street 2:A
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2601
Mailing Address - Country:US
Mailing Address - Phone:757-668-6020
Mailing Address - Fax:757-668-6025
Practice Address - Street 1:5835 HARBOUR VIEW BLVD
Practice Address - Street 2:A
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2601
Practice Address - Country:US
Practice Address - Phone:757-668-6020
Practice Address - Fax:757-668-6025
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10136225100000X
VA2305205848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist