Provider Demographics
NPI:1760597181
Name:GRAY, DIANE S (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:S
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 1:31 HALL DR
Mailing Address - Street 2:AMHERST MEDICAL CENTER
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2751
Mailing Address - Country:US
Mailing Address - Phone:413-256-4415
Mailing Address - Fax:413-256-4490
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-4415
Practice Address - Fax:413-256-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y67942OtherBLUE CROSS
650017524OtherRAILROAD MEDICARE
042472266OtherHEALTHCARE VALUE MANAGEME
0394742OtherMEDICAID WELFARE
MA0394742Medicaid
115682OtherFALLON COMMUNITY HEALTH P