Provider Demographics
NPI:1851617450
Name:GRAY, EARL WARREN (CMT)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:WARREN
Last Name:GRAY
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S HOWES ST
Mailing Address - Street 2:BLDG. A, SUITE 203
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2871
Mailing Address - Country:US
Mailing Address - Phone:970-232-8966
Mailing Address - Fax:
Practice Address - Street 1:420 S HOWES ST
Practice Address - Street 2:BLDG. A, SUITE 203
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2871
Practice Address - Country:US
Practice Address - Phone:970-232-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist