Provider Demographics
NPI:1265890198
Name:GRAY, JONATHAN (PTA)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
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 1:15 ALLESARN RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2234
Mailing Address - Country:US
Mailing Address - Phone:424-202-4739
Mailing Address - Fax:
Practice Address - Street 1:1635 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2305
Practice Address - Country:US
Practice Address - Phone:828-693-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5824225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant