Provider Demographics
NPI:1700829660
Name:GRAYSON, RACHEL LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEE
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 W MAIN ST
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4657
Mailing Address - Country:US
Mailing Address - Phone:405-364-8700
Mailing Address - Fax:
Practice Address - Street 1:3750 W MAIN ST
Practice Address - Street 2:SUITE 3E
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4657
Practice Address - Country:US
Practice Address - Phone:405-364-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK249601802Medicare PIN