Provider Demographics
NPI:1396498622
Name:GRAY, PATRICIA STANAT (MS PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:STANAT
Last Name:GRAY
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:27 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4418
Mailing Address - Country:US
Mailing Address - Phone:857-373-9332
Mailing Address - Fax:
Practice Address - Street 1:431 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1537
Practice Address - Country:US
Practice Address - Phone:617-663-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2911208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation