Provider Demographics
NPI:1801814827
Name:GRAY, JENNIFER F (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5088 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3120
Mailing Address - Country:US
Mailing Address - Phone:727-541-2675
Mailing Address - Fax:727-541-3956
Practice Address - Street 1:5088 66TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-3120
Practice Address - Country:US
Practice Address - Phone:727-541-2675
Practice Address - Fax:727-541-3956
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 17196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist