Provider Demographics
NPI:1841801719
Name:GRAY, TERRA M (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MS
Other - First Name:TERRA
Other - Middle Name:M
Other - Last Name:SALISBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:935 BOB WALLACE AVE SW STE 105
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6541
Mailing Address - Country:US
Mailing Address - Phone:256-384-1178
Mailing Address - Fax:
Practice Address - Street 1:935 BOB WALLACE AVE SW STE 105
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6541
Practice Address - Country:US
Practice Address - Phone:256-384-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist