Provider Demographics
NPI:1184747552
Name:GILRAY, JODI R (PT, DPT, C/NDT)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:R
Last Name:GILRAY
Suffix:
Gender:F
Credentials:PT, DPT, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 E 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3523
Mailing Address - Country:US
Mailing Address - Phone:928-771-9327
Mailing Address - Fax:928-771-9519
Practice Address - Street 1:6550 E 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-3523
Practice Address - Country:US
Practice Address - Phone:928-771-9327
Practice Address - Fax:928-771-9519
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6784225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106361Medicare PIN