Provider Demographics
NPI:1487103297
Name:GRAY, BRITTANY (PTA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-0824
Mailing Address - Country:US
Mailing Address - Phone:928-337-3020
Mailing Address - Fax:928-337-3979
Practice Address - Street 1:80 SOUTH 13TH WEST
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-3020
Practice Address - Fax:928-337-3979
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12529A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant