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NPI Code Detail

MEDICARE: LILLIAN KATHERINE GRAY AA

MEDICARE: LILLIAN KATHERINE GRAY AA
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
1225400000XRehabilitation Practitioner

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 : 1407144389
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLIAN KATHERINE GRAY AA
Provider Business Mailing Address
First Line : 245 RUTH ST N STE 105
Second Line :
City : SAINT PAUL
State : MN
Zip : 55119-4409
Country : US
Telephone Number : 651-447-2118
Fax Number : 651-447-2120
Provider Business Practice Location Address
First Line : 245 RUTH ST N STE 105
Second Line :
City : SAINT PAUL
State : MN
Zip : 55119-4409
Country : US
Telephone Number : 651-447-2118
Fax Number : 651-447-2120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2011
Last Update Date : 06/18/2025

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Directions to “ LILLIAN KATHERINE GRAY AA” Practice Location

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