Provider Demographics
NPI:1699833467
Name:GRAY, NORMAN (PT)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:NORMAN
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:11950 JONES BRIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8911
Mailing Address - Country:US
Mailing Address - Phone:770-475-8221
Mailing Address - Fax:770-619-9606
Practice Address - Street 1:11950 JONES BRIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8911
Practice Address - Country:US
Practice Address - Phone:770-475-8221
Practice Address - Fax:770-619-9606
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000388OtherLICENSE NUMBER