Provider Demographics
NPI:1720380371
Name:GRAY, KRISTA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:L
Last Name:GRAY
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 1:1301 S SEWARD MERIDIAN PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8369
Mailing Address - Country:US
Mailing Address - Phone:907-982-4955
Mailing Address - Fax:907-376-3486
Practice Address - Street 1:1301 S SEWARD MERIDIAN PKWY STE C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8369
Practice Address - Country:US
Practice Address - Phone:907-982-4955
Practice Address - Fax:907-376-3486
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK948310174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator