Provider Demographics
NPI:1801051198
Name:GRAY, KIMBERLY ANN OGDEN (PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN OGDEN
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 LOUGHBORO RD NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2618
Mailing Address - Country:US
Mailing Address - Phone:317-670-7385
Mailing Address - Fax:
Practice Address - Street 1:5215 LOUGHBORO RD NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2618
Practice Address - Country:US
Practice Address - Phone:317-670-7385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003589A225200000X
DCPT871438225100000X
VA2305207507225100000X
MD24113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant