Healthcare Provider Details

I. General information

NPI: 1871053520
Provider Name (Legal Business Name): PAULA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 E NORTHERN LIGHTS BLVD
ANCHORAGE AK
99508-4101
US

IV. Provider business mailing address

2008 E NORTHERN LIGHTS BLVD
ANCHORAGE AK
99508-4101
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-6325
  • Fax:
Mailing address:
  • Phone: 907-376-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number143315
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: