Provider Demographics
NPI:1740627850
Name:GRAY, ARLENE PATRICIA
Entity type:Individual
Prefix:MS
First Name:ARLENE
Middle Name:PATRICIA
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ROBINSON ST STE 1120
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1962
Mailing Address - Country:US
Mailing Address - Phone:407-272-5088
Mailing Address - Fax:
Practice Address - Street 1:200 E ROBINSON ST STE 1120
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1962
Practice Address - Country:US
Practice Address - Phone:407-272-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL02135921744P3200X
224900000X, 335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No335E00000XSuppliersProsthetic/Orthotic Supplier