Provider Demographics
NPI:1477722916
Name:GRAY, ERIK GLEN (MPT)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:GLEN
Last Name:GRAY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 W 2010 N
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-8031
Mailing Address - Country:US
Mailing Address - Phone:801-796-7761
Mailing Address - Fax:
Practice Address - Street 1:1498 W 2010 N
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-8031
Practice Address - Country:US
Practice Address - Phone:801-796-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341544-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist