Provider Demographics
NPI:1740402494
Name:GRAY, BRANT LEE (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRANT
Middle Name:LEE
Last Name:GRAY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8394 FULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7337
Mailing Address - Country:US
Mailing Address - Phone:214-934-1935
Mailing Address - Fax:
Practice Address - Street 1:9441 LYNDON B JOHNSON FWY STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4566
Practice Address - Country:US
Practice Address - Phone:866-575-9820
Practice Address - Fax:214-575-9846
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1157312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist