Provider Demographics
NPI:1568731511
Name:GRAY, CARRIE LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 BUSINESS PARK BLVD STE D-24
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7142
Mailing Address - Country:US
Mailing Address - Phone:907-561-1478
Mailing Address - Fax:888-552-1720
Practice Address - Street 1:12001 BUSINESS BLVD STE 179
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7743
Practice Address - Country:US
Practice Address - Phone:907-726-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12612251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1577375Medicaid