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NPI Code Detail

MEDICARE: CARRIE DIANE GRAY M.P.T.

MEDICARE: CARRIE DIANE GRAY M.P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT3813OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205815610
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE DIANE GRAY M.P.T.
Provider Business Mailing Address
First Line : 2475 BOARDWALK
Second Line :
City : NORMAN
State : OK
Zip : 73069-6332
Country : US
Telephone Number : 405-447-1991
Fax Number : 405-447-1198
Provider Business Practice Location Address
First Line : 2340 NW 32ND ST
Second Line :
City : NEWCASTLE
State : OK
Zip : 73065-6589
Country : US
Telephone Number : 405-392-3322
Fax Number : 405-392-3356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 08/26/2014

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