Provider Demographics
NPI:1639954225
Name:GRAY, NIYA (PT)
Entity Type:Individual
Prefix:
First Name:NIYA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5205 LEESBURG PIKE STE 903
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3889
Mailing Address - Country:US
Mailing Address - Phone:757-990-2833
Mailing Address - Fax:855-678-8887
Practice Address - Street 1:9207 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2501
Practice Address - Country:US
Practice Address - Phone:855-678-8887
Practice Address - Fax:855-678-8887
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305216043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist