Provider Demographics
NPI:1821078221
Name:GRAY, KRISTEN MELISSA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MELISSA
Last Name:GRAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GREENTREE RD
Mailing Address - Street 2:SUITE A116
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1400
Mailing Address - Country:US
Mailing Address - Phone:412-276-8644
Mailing Address - Fax:412-276-8648
Practice Address - Street 1:2101 GREENTREE RD
Practice Address - Street 2:SUITE A116
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1400
Practice Address - Country:US
Practice Address - Phone:412-276-8644
Practice Address - Fax:412-276-8648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013605L225100000X
PADAPT000486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA856491OtherHIGHMARK
PA2937423OtherAETNA
PA856491OtherHIGHMARK