Provider Demographics
NPI:1245937077
Name:GRAY, SCOTTIE NICHOLLS (PT)
Entity type:Individual
Prefix:
First Name:SCOTTIE
Middle Name:NICHOLLS
Last Name:GRAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 4TH STREET LN NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-9013
Mailing Address - Country:US
Mailing Address - Phone:828-228-6224
Mailing Address - Fax:
Practice Address - Street 1:328 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-9765
Practice Address - Country:US
Practice Address - Phone:704-827-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist