Provider Demographics
NPI:1184870008
Name:GRAY, KENNETH P (PTA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:P
Last Name:GRAY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 N CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-1121
Mailing Address - Country:US
Mailing Address - Phone:585-727-8605
Mailing Address - Fax:
Practice Address - Street 1:311 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9798
Practice Address - Country:US
Practice Address - Phone:585-335-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003271-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant