Provider Demographics
NPI:1609049352
Name:GRAY, RICHARD W (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:GRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1834A JACLIF CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4400
Mailing Address - Country:US
Mailing Address - Phone:850-656-1837
Mailing Address - Fax:850-877-2917
Practice Address - Street 1:1834A JACLIF CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4400
Practice Address - Country:US
Practice Address - Phone:850-656-1837
Practice Address - Fax:850-877-2917
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK381ZMedicare PIN