Provider Demographics
NPI:1972675221
Name:GRAY, MICHELLE M (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 ENTERPRISE WAY NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4472
Mailing Address - Country:US
Mailing Address - Phone:256-713-1872
Mailing Address - Fax:256-713-1873
Practice Address - Street 1:165 WHITESPORT DR SW
Practice Address - Street 2:SUITE 2
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6484
Practice Address - Country:US
Practice Address - Phone:256-425-0300
Practice Address - Fax:256-461-9728
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51522836OtherBCBS
AL51521715OtherBCBS
AL51522836OtherBCBS