Provider Demographics
NPI:1619732989
Name:GRAY, NATALIE FAITH (PTA)
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:FAITH
Last Name:GRAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:762 OAKLEAF RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8161
Mailing Address - Country:US
Mailing Address - Phone:937-798-5959
Mailing Address - Fax:
Practice Address - Street 1:5280 US HIGHWAY 62 AND 68
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-8650
Practice Address - Country:US
Practice Address - Phone:937-392-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013674225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant