Provider Demographics
NPI:1952551590
Name:GRAY, DIANA C (PT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:C
Last Name:GRAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11135 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1253
Mailing Address - Country:US
Mailing Address - Phone:314-822-4400
Mailing Address - Fax:314-822-4111
Practice Address - Street 1:11135 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1253
Practice Address - Country:US
Practice Address - Phone:314-822-4400
Practice Address - Fax:314-822-4111
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO013292251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports