Provider Demographics
NPI:1255527305
Name:GRAY, MATTHEW PATRICK (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PATRICK
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 1:894 SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4455
Mailing Address - Country:US
Mailing Address - Phone:720-323-0698
Mailing Address - Fax:
Practice Address - Street 1:894 SPRUCE CT
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4455
Practice Address - Country:US
Practice Address - Phone:720-323-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist