Provider Demographics
NPI:1558434514
Name:MACGRAY, BEVERLY JEAN IV (LPT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:JEAN
Last Name:MACGRAY
Suffix:IV
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 BERKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5705
Mailing Address - Country:US
Mailing Address - Phone:214-696-3500
Mailing Address - Fax:214-696-4090
Practice Address - Street 1:6015 BERKSHIRE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5705
Practice Address - Country:US
Practice Address - Phone:214-696-3500
Practice Address - Fax:214-696-4090
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-8387-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2112OtherBLUE CROSS BLUE SHIELD
TX8B9591Medicare ID - Type Unspecified