Provider Demographics
NPI:1558941690
Name:GRAY, MICHAEL PETER
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SPOFFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03462-4419
Mailing Address - Country:US
Mailing Address - Phone:603-606-0487
Mailing Address - Fax:
Practice Address - Street 1:415 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4310
Practice Address - Country:US
Practice Address - Phone:603-606-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist