Provider Demographics
NPI:1790978963
Name:WREFORD, GARY FREDERICK (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:FREDERICK
Last Name:WREFORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17470 27 MILE RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:MI
Mailing Address - Zip Code:48096-3509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17470 27 MILE RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:MI
Practice Address - Zip Code:48096-3509
Practice Address - Country:US
Practice Address - Phone:586-781-7013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist