Provider Demographics
NPI:1215993621
Name:GRAYGO, DAVID MICHAEL (MPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:GRAYGO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 ENGLE RD
Mailing Address - Street 2:STE 105
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-8401
Mailing Address - Country:US
Mailing Address - Phone:440-260-3733
Mailing Address - Fax:260-239-0979
Practice Address - Street 1:7010 ENGLE RD
Practice Address - Street 2:STE 105
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8401
Practice Address - Country:US
Practice Address - Phone:440-260-3733
Practice Address - Fax:260-239-0979
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT011410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000390268OtherANTHEM
OH9427360OtherPHCS
OHP00313282OtherMEDICARE RAILROAD
OH2682897Medicaid
OH9427360OtherPHCS
OHGR4182291Medicare PIN