Provider Demographics
NPI:1639983240
Name:GRAY, ERIN LEANNE (LMT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEANNE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 MORENO DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3152
Mailing Address - Country:US
Mailing Address - Phone:805-390-1383
Mailing Address - Fax:
Practice Address - Street 1:1720 E LOS ANGELES AVE STE 220
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5819
Practice Address - Country:US
Practice Address - Phone:805-390-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist