Provider Demographics
NPI:1619284247
Name:GRAYS, ANITA DOREEN (MSPT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:DOREEN
Last Name:GRAYS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 STATE HIGHWAY 357
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-2399
Mailing Address - Country:US
Mailing Address - Phone:607-369-4531
Mailing Address - Fax:
Practice Address - Street 1:6110 COUNTY RTE 32
Practice Address - Street 2:SECO PO 1046
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-334-5010
Practice Address - Fax:607-336-7326
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist