Provider Demographics
NPI:1598756553
Name:GRAY, KYNDRA L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KYNDRA
Middle Name:L
Last Name:GRAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KYNDRA
Other - Middle Name:L
Other - Last Name:GEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4080 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5267
Mailing Address - Country:US
Mailing Address - Phone:559-222-7497
Mailing Address - Fax:559-224-9310
Practice Address - Street 1:4080 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5267
Practice Address - Country:US
Practice Address - Phone:559-222-7497
Practice Address - Fax:559-224-9310
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT229001Medicare PIN