Provider Demographics
NPI:1710289343
Name:GRAY, ROBERT BENJAMIN (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:GRAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2511
Mailing Address - Country:US
Mailing Address - Phone:205-263-2770
Mailing Address - Fax:205-263-0994
Practice Address - Street 1:2808 7TH AVE S
Practice Address - Street 2:SUITE 111
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2813
Practice Address - Country:US
Practice Address - Phone:205-745-3976
Practice Address - Fax:205-453-4221
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH6019OtherSTATE LICENSE NUMBER