Provider Demographics
NPI:1770750085
Name:GRAY, JANA M (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:M
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:MARY
Other - Last Name:WARDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3125 PERICLES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7180
Mailing Address - Country:US
Mailing Address - Phone:207-852-5616
Mailing Address - Fax:
Practice Address - Street 1:6235 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2285
Practice Address - Country:US
Practice Address - Phone:207-852-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3303225100000X, 225100000X
FLPT26403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist